tbuckley/cabot-search huggingface dataset:
PTH-067 Setting Up A Hepatology Econsult Service – Beneficial For Patients And Primary Care, But Perhaps A Hardship For Secondary Care?
Authors: S Moreea, VJ Appleby, B Smith, PB Southern, J Connolly
Journal: Gut (2014)

<h3>Introduction</h3> Due to the heavy burden of liver disease, new policies are required to improve information flow between primary care (PC) and secondary care (SC). Outpatient visits are costly to PC, time consuming for patients and not always appropriate. Developing interventions to increase care available in PC is desirable and likely cost effective. We developed a hepatology eConsult (eC) service, allowing PC clinicians to send a referral and share a patient's medical record electronically with SC using a PC database. <h3>Methods</h3> Service set up: Discussions between PC and SC identified a need for the service, and thorough review of the current Hepatology service was undertaken, focussing on current and projected working practices, service demands as well as clinicians job plans. Once eC was agreed in principle, a price of £23 per eC and a timescale of 7 days for eC to be completed was agreed with the CCG. A risk assessment of the service was performed and a comprehensive set of guidelines devised for use in PC, ensuring that only appropriate and timely referrals are made. Prior to launching the service, IT systems were updated, and appropriate training delivered to clinicians. To ensure smooth running of eC, user guides and support documents were created and distributed. Making and processing a referral using eC: Once a referral has been made in PC, it appears on-line and a hepatology secretary logs the referral, opening the episode of care and informs the designated hepatologist that a referral has been received. The eC takes approximately 15 min of consultant time to complete but varies depending on case complexity. Once completed, the hepatologist informs the secretary and they log a 'completed episode of care' ensuring the trust is paid for the clinical encounter. Referrals are audited on a 6 monthly basis. <h3>Results</h3> Between March 2012 – Oct 2013, 81 eC were completed (12 in months 1–6, 16 in months 7–12, 40 in months 13–18, 13 in months 19–20). A SC appointment was avoided in 78% of patients (n = 63) resulting in a cost saving to PC of £16,443 [63 x eC(£23) = 1,449 vs 63 x new patient referrals (£181) = £11,403 + 1x follow up/patientn (£103) = £6489). Median response time for eC was 2 days, 43% were completed within the same working day. <h3>Conclusion</h3> Hepatology eC is beneficial for patient care, with specialist advice being provided within one working day in a substantial number of cases, and is clearly cost effective, making eC popular with PC. However, until a more slim-line IT system is developed reducing the number of steps involved in completing an eC, and the cost per eC increased, it appears to be beneficial for all parties except SC. <h3>Disclosure of Interest</h3> None Declared.
Development and functional evaluation of biomimetic silicone surfaces with hierarchical micro/nano-topographical features demonstrates favourable in vitro foreign body response of breast-derived fibroblasts
Authors: Daniel J.T. Kyle, Antonios Oikonomou, Ernie Hill, Ardeshir Bayat
Journal: Biomaterials (2015)

Reproducing extracellular matrix topographical cues, such as those present within acellular dermal matrix (ADM), in synthetic implant surfaces, may augment cellular responses, independent of surface chemistry. This could lead to enhanced implant integration and performance while reducing complications. In this work, the hierarchical micro and nanoscale features of ADM were accurately and reproducibly replicated in polydimethylsiloxane (PDMS), using an innovative maskless 3D grayscale fabrication process not previously reported. Human breast derived fibroblasts (n=5) were cultured on PDMS surfaces and compared to commercially available smooth and textured silicone implant surfaces, for up to one week. Cell attachment, proliferation and cytotoxicity, in addition to immunofluorescence staining, SEM imaging, qRT-PCR and cytokine array were performed. ADM PDMS surfaces promoted cell adhesion, proliferation and survival (p=<0.05), in addition to increased focal contact formation and spread fibroblast morphology when compared to commercially available implant surfaces. PCNA, vinculin and collagen 1 were up-regulated in fibroblasts on biomimetic surfaces while IL8, TNFα, TGFβ1 and HSP60 were down-regulated (p=<0.05). A reduced inflammatory cytokine response was also observed (p=<0.05). This study represents a novel approach to the development of functionalised biomimetic prosthetic implant surfaces which were demonstrated to significantly attenuate the acute in vitro foreign body reaction to silicone.
The mammography controversy
Authors: Peter C Gotzsche
Journal: The Lancet (2005)

A 40-year-old woman at her first mammography screening session is told that she has carcinoma-in-situ and needs a mastectomy and radiotherapy. She is in doubt, however. She has seen advertisements saying that "mammograms can save your life", but one of her friends was similarly diagnosed and treated and is now divorced. This friend got depressed because the treatment led to disfigurement of her body, and she became so obsessed with her "disease" and the risk that she might die from cancer, that it ruined her sex-life and marriage.
Measurement of physiological recovery from exacerbation of chronic obstructive pulmonary disease using within-breath forced oscillometry
Authors: M. K Johnson, M. Birch, R. Carter, J. Kinsella, R. D Stevenson
Journal: Thorax (2006)

Within-breath reactance from forced oscillometry estimates resistance via its inspiratory component (X(rs,insp)) and flow limitation via its expiratory component (X(rs,exp)).To assess whether reactance can detect recovery from an exacerbation of chronic obstructive pulmonary disease (COPD).39 subjects with a COPD exacerbation were assessed on three occasions over 6 weeks using post-bronchodilator forced oscillometry, arterial blood gases, spirometry including inspiratory capacity, symptoms and health-related quality of life (HRQOL).Significant improvements were seen in all spirometric variables except the ratio of forced expiratory volume in 1 s (FEV(1)) to vital capacity, ranging in mean (SEM) size from 11.0 (2.2)% predicted for peak expiratory flow to 12.1 (2.3)% predicted for vital capacity at 6 weeks. There was an associated increase in arterial partial pressure of oxygen (PaO(2)). There were significant mean (SEM) increases in both X(rs,insp) and X(rs,exp) (27.4 (6.7)% and 37.1 (10.0)%, respectively) but no change in oscillometry resistance (R(rs)) values. Symptom scales and HRQOL scores improved. For most variables, the largest improvement occurred within the first week with spirometry having the best signal-to-noise ratio. Changes in symptoms and HRQOL correlated best with changes in FEV(1), PaO(2) and X(rs,insp).The physiological changes seen following an exacerbation of COPD comprised both an improvement in operating lung volumes and a reduction in airway resistance. Given the ease with which forced oscillometry can be performed in these subjects, measurements of X(rs,insp) and X(rs,exp) could be useful for tracking recovery.
Inflammatory Breast Carcinoma and Noninflammatory Locally Advanced Breast Carcinoma: Distinct Clinicopathologic Entities?
Authors: William F. Anderson, Kenneth C. Chu, Shine Chang
Journal: Journal of Clinical Oncology (2003)

Inflammatory breast carcinoma (IBC) and noninflammatory locally advanced breast carcinoma (LABC) are both associated with poor prognosis; however, whether they are distinct clinicopathologic entities remains controversial.To determine whether IBC and LABC were different, we compared tumor characteristics, prognosis, and age-specific incidence rate patterns in the Surveillance, Epidemiology, and End-Results program. An age of 50 years served as a surrogate marker for menopause.Younger age at diagnosis, poorer tumor grade, and negative estrogen receptors (ERs) were more predictive of IBC (n = 2,237) than of LABC (n = 7,985). Breast carcinoma survival was worse for patients with IBC than for those with LABC (log-rank test, P <.0001). Age-specific incidence rates for IBC increased until 50 years and then flattened, whereas rates for LABC increased for all ages. When rates for LABC were stratified by estrogen receptor-positive (ERP) and -negative (ERN) expression, rates for ERP and ERN diverged; that is, rates for ERP increased with advancing age, whereas rates for ERN flattened after 50 years. When rates for IBC were stratified by ER expression, rates for both ERP and ERN flattened after 50 years of age.IBC and LABC seemed to be distinct biologic entities, as indicated by different prognostic factor profiles and age-specific incidence rate patterns. Rates that increased before 50 years and then stabilized, possibly indicated that premenopausal exposures had a greater effect on maintaining rates for IBC than for LABC.
Screening children for visual defects.
Authors: R M Youngson
Journal: BMJ (1977)

them making some attempt to reduce their intake.If this small group of adolescents attending a diabetic summer camp is at all representative of the adolescent diabetic population as a whole, then these findings would suggest that control of hyperglycaemia in our young diabetics is far from satisfactory.It is pertinent to note that of the 10 patients who preferred persistent glycosuria on urine testing, six felt that their hospital doctors were satisfied with these tests.If the incidence of distressing complications of diabetes is to be reduced, then it would seem necessary to lay the foundations of good diabetic control in our young diabetics, as in the adult clinics it is often very difficult to change long-standing habits of maintaining persistent glycosuria or even to transfer patients previously on one injection to two injections of insulin a day.
Evolving Role of SPECT/CT in Neuroendocrine Tumors Management
Authors: Chiara Fuccio, Elena Giulia Spinapolice, Sotirios Chondrogiannis, Anna Margherita Maffione, Giuseppe Trifirò, Patrick M. Colletti, Domenico Rubello
Journal: Clinical Nuclear Medicine (2013)

The combined use of SPECT and CT strongly supports the molecular imaging of neuroendocrine tumors (NETs) with somatostatin receptor radiopharmaceuticals or with meta-iodobenzylguanidine. SPECT/CT fusion images provide potential attenuation correction, higher specificity, and accurate localization for the staging, evaluation of treatment response, and follow-up of NETs.
Paraplegia after Resection of Aneurysms of the Abdominal Aorta
Authors: John J. Skillman, Nicholas T. Zervas, Ronald M. Weintraub, Chaim I. Mayman
Journal: New England Journal of Medicine (1969)

IN an exhaustive review of the neurologic complications of aortic surgery published in 1956, Adams and van Geertruyden1 were unable to find a single case of spinal-cord damage after intraoperative ...
Anti-HIV Microbicide Efforts Press On
Authors: Rebecca Voelker
Journal: JAMA (2006)

For years the road towards development of a safe effective anti-HIV microbicide seemingly has been strewn with disappointment and setbacks. Nonoxynol-9 the spermicide heralded as a promising vaginal microbicide fell by the wayside after a number of animal and clinical studies produced conflicting or negative results. Few other compounds were under active development research funding was scarce and pharmaceutical manufacturers were less than eager to leap into the field. But after a trip back to the proverbial drawing board experts say there is reason for optimism that a safe effective topical anti-HIV microbicide will be developed and licensed in the not-too-distant future. Five microbicidal agents currently are being examined in 6 clinical efficacy trials another dozen or so are in earlier phases of clinical study and more than 60 products or compounds are under development. The research pipeline holds additional promise in antiretroviral drugs such as tenofovir that are being studied to determine if they are as potent in topical formulations as they are in pills. And in recent years some pharmaceutical firms have shaken off their reluctance by entering into partnerships with nonprofit organizations and foundations to expedite microbicide research and development.  (excerpt)
Physician Race and Care of Minority and Medically Indigent Patients
Authors: Ernest Moy
Journal: JAMA (1995)

<h3>Objective.</h3> —To examine the relationship between physician race and care of racial minority and ethnic minority patients and medically indigent patients. <h3>Design.</h3> —Secondary analysis of data from the 1987 National Medical Expenditure Survey, a cross-sectional survey of Americans designed to provide national estimates of health care utilization and expenditures. <h3>Setting.</h3> —A sample representative of the total civilian noninstitutionalized US population with oversampling of minorities and the medically indigent. <h3>Patients.</h3> —Survey respondents aged 18 years or older who identified a specific physician as their usual source of care (n=15081, corresponding to a national population estimate of 116 million Americans). <h3>Main Outcome Measure.</h3> —Identification of a nonwhite physician as usual source of care. <h3>Results.</h3> —Of adult Americans who identified a usual-source-of-care physician, 14.4% identified a nonwhite physician as that source of care. Minority patients were more than four times more likely to receive care from nonwhite physicians than were non-Hispanic white patients. Low-income, Medicaid, and uninsured patients were also more likely to receive care from nonwhite physicians. Individuals who receive care from nonwhite physicians were more likely to report worse health, visit an emergency department, and be hospitalized. Individuals who receive care from nonwhite physicians reported more acute complaints, chronic conditions, functional limitations, and psychological symptoms as well as longer visits. <h3>Conclusions.</h3> —Nonwhite physicians are more likely to care for minority, medically indigent, and sicker patients. Caring for less affluent and sicker patients may financially penalize nonwhite physicians and make them particularly vulnerable to capitation arrangements. (<i>JAMA</i>. 1995;273:1515-1520)
THE SURGICAL TREATMENT OF GRANULAR CONJUNCTIVITIS.
Authors: J. A. BACH
Journal: JAMA (1894)

The important feature in all forms of treatment of granulations of the eye-lids, whether surgical or otherwise, is to remove pathologic elements and prevent further invasion of the same with their destructive consequences, with the least possible harm to the conjunctiva and lids. Without proper treatment we know that granulations will in many cases ruin eyes, and in others cause serious lesions, either by inducing ulcerative processes or, in the more favorable cases, by producing cicatricial contractions and deformities of the lids. In fact, a large percentage of cases as they come for treatment, have already suffered in some way or other in the mobility or form of the eye-lids. These complications by the additional irritation they induce, further aggravate the unpleasant symptoms and not infrequenlly produce spasmodic contractions of the muscles of the lids, forming a serious obstacle to the successful treatment of the case. Therefore, often one of
CELLS MEDIATING SPECIFIC IN VITRO CYTOTOXICITY
Authors: Pierre Golstein, Hans Wigzell, Henric Blomgren, Erik A. J. Svedmyr
Journal: The Journal of Experimental Medicine (1972)

In order to investigate whether only T cells are involved in a cell-mediated cytotoxic system in vitro, we tested the cytotoxicity of immune killing cell populations as deprived as possible of B cells. Educated thymus cells, immune spleen cells purified by filtration through a column of beads coated with antimouse Ig antiserum, and finally educated thymus cells further purified by filtration through such a column fully retained their specific cytotoxic activity. This very strongly suggests that only T cells are involved in the killing of target cells by allogeneic immune cells in vitro, in this system. Receptor-bearing cells involved in killing in the present system are thus very probably T cells. This point was further strengthened by the demonstration of specific adsorption, on the relevant monolayers, of each of the three above mentioned killing cell populations.
Ovarian neoplasms, functional ovarian cysts, and oral contraceptives.
Authors: M Vessey, A Metcalfe, C Wells, K McPherson, C Westhoff, D Yeates
Journal: BMJ (1987)

The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year.
NEPHROTRESIS FOR RECURRENT BILATERAL PYELOLITHIASIS IN HORSESHOE KIDNEY
Authors: KERWIN KINARD
Journal: JAMA (1923)

Janosik in 1887<sup>1</sup>found, in a 3 mm. embryo of about 18 to 19 days, what he described as the pronephros or head kidney. It consisted of two rudimentary tubules, which were funnel shaped structures of peritoneum, and they extended from the mesothelial lining of the body cavity toward the primary excretory duct or the pronephric duct, into which one of the tubules opened. The pronephros is a vestigial structure having a brief existence, and probably no functional activity. It represents the earliest development of the excretory system. The mesonephros, or wolffian body, is developed as the intermediary organ of excretion between the time of degeneration of the pronephros and the appearance of the metanephros, or permanent kidney. The pronephros evolves the fundamental plan on which is based in a modified form the subsequent development of both the mesonephros and the metanephros. The paraxial mesoblast extends from the neural
Cardioprotection During the Final Stage of the Late Phase of Ischemic Preconditioning Is Mediated by Neuronal NO Synthase in Concert With Cyclooxygenase-2
Authors: Yang Wang, Eitaro Kodani, Jianxun Wang, Shelley X. Zhang, Hitoshi Takano, Xian-Liang Tang, Roberto Bolli
Journal: Circulation Research (2004)

The infarct-sparing effect of the late phase of ischemic preconditioning (late PC) lasts for 72 hours. Upregulation of both cyclooxygenase-2 (COX-2) and inducible NO synthase (iNOS) has been shown to be essential to the protection in the initial stage of late PC (24 hours after PC); however, the mechanisms underlying the protection in the final stage of late PC (48 to 72 hours after PC) are unknown. Conscious rabbits were preconditioned with six cycles of 4-minute coronary occlusion/4-minute reperfusion. At 72 hours after PC, powerful protection against infarction was associated with increased myocardial levels of COX-2 mRNA, protein, and cardioprotective prostaglandins (PGI2 and PGE2). The COX-2-selective inhibitor NS-398 completely blocked the protection. Surprisingly, iNOS expression was not increased at 72 hours; instead, upregulation of neuronal NO synthase (nNOS) was evident at both the mRNA (+266+/-20%, P<0.005) and the protein levels (+195+/-66%, P<0.005), which was accompanied by an increase in myocardial nitrite/nitrate (+20+/-4%, P<0.05). The nNOS-selective inhibitors N-propyl-l-arginine or S-ethyl N-[4-(trifluoromethyl)phenyl]isothiourea completely blocked the protection of late PC at 72 hours, whereas the iNOS-selective inhibitor S-methylisothiourea had no effect. In line with these findings, the disappearance of protection at 120 hours after PC was associated with the return of nNOS mRNA, protein, and activity to control levels. Although expression of COX-2 protein was still elevated at 120 hours, only a marginal increase in PGI2 and PGE2 levels was detected. In contrast to 72 hour after PC, nNOS was not upregulated at 24 hour after PC. We conclude that (1) the cardioprotection observed in the final stage of late PC (72 hour) is mediated by nNOS, not by iNOS, in concert with COX-2, and (2) nNOS-derived NO is required to drive COX-2 activity. These data identify, for the first time, a cardioprotective role of nNOS and demonstrate, surprisingly, that the mechanism of late PC differs at 72 hours (nNOS) versus 24 hours (iNOS).
Mandatory Screening for HIV Antibody-Reply
Authors: Ronald Bayer
Journal: JAMA (1987)

In Reply.—  Dr Alvig has misread our article. But his letter demonstrates how anxiety about AIDS can foster illusions that coercive public health measures can halt the spread of HIV infection.  At the outset of our article, we acknowledged the gravity of the public health crisis posed by AIDS, a crisis underscored by the recently released Institute of Medicine report, Confronting AIDS . In the face of such a crisis, we offered an analysis of how HIV antibody screening could be used ethically. We argued that it must be part of an overall strategy of encouraging millions of men and women to alter their sexual and drug-using behavior, as well as their childbearing plans, to avoid infecting themselves and others. We also argued for wide-scale voluntary use of the test and concluded that there are limited ways in which nonvoluntary screening might be appropriate.  Our analysis examined the ways in which
Technetium-99m MDP vs Technetium-99m Dicarboxypropane Diphosphonate
Authors: G??RARD GODART, MARIANNE DUREZ, MICHEL BEVILACQUA, JEAN ABRAMOVICI, YVON ROBIENCE
Journal: Clinical Nuclear Medicine (1986)

The performance of Tc-99m MDP vs Tc-99m dicarboxypropane diphosphonate (DPD) was evaluated in 20 patients with various skeletal bone diseases. Each patient was investigated twice, with an interval of three days between studies and using the same protocol, hence each case served as its own control. The results were: 1) In a subjective interpretation by five independent and experienced investigators, the difference between agents was small, yet in favor of MDP. 2) Region of interest (ROI) analysis of the pooled results in 74.4% of all cases shows a higher bone lesion to normal bone ratio (BL/NB), and in 79.3% of all cases, a better bone lesion to soft tissue ratio (BL/ST) with Tc-99m MDP. 3) When considering pathology types separately, the BL/NB ratio of Tc-99m MDP was 17.7% higher than the one of Tc-99m DPD in metastases, 9.5% higher in rheumatoid arthritis, 2.8% higher in metabolic diseases, and 24% higher in bone fractures. 4) Student's paired t test on the pooled BL/NB ratios shows a difference of 15.5% for Tc-99m MDP, significant at P = 0.00155. The overall results of our study favor Tc-99m MDP.
Histiocytosis X in an elderly patient. Ultrastructure and immunocytochemistry after PUVA photochemotherapy
Authors: CHRISTINE NEUMANN, G. KOLDE, GISELA BONSMANN
Journal: British Journal of Dermatology (1988)

The clinical features of a 76-year-old man with histiocytosis X of the Letterer-Siwe type, with extensive skin involvement, are described. The patient's lesions responded dramatically to PUVA-photochemotherapy. Light microscopic, immunocytochemical and immunoelectron microscopic findings, before and after PUVA, are reported. Birbeck granules in phagolysosomes of dermal macrophages indicated uptake of destroyed HX cells. Residual HX cells in the skin and HX cells in a recurring lesion expressed the same membrane antigens as in the primary lesions.