tbuckley/cabot-search huggingface dataset:
Opioid Prescriptions for Chronic Pain and Overdose
Authors: Kate M. Dunn
Journal: Annals of Internal Medicine (2010)

Background: Long-term opioid therapy for chronic noncancer pain is becoming increasingly common in community practice. Concomitant with this change in practice, rates of fatal opioid overdose have increased. The extent to which overdose risks are elevated among patients receiving medically prescribed long-term opioid therapy is unknown. Objective: To estimate rates of opioid overdose and their association with an average prescribed daily opioid dose among patients receiving medically prescribed, long-term opioid therapy. Design: Cox proportional hazards models were used to estimate overdose risk as a function of average daily opioid dose (morphine equivalents) received at the time of overdose. Setting: HMO. Patients: 9940 persons who received 3 or more opioid prescriptions within 90 days for chronic noncancer pain between 1997 and 2005. Measurements: Average daily opioid dose over the previous 90 days from automated pharmacy data. Primary outcomes—nonfatal and fatal overdoses—were identified through diagnostic codes from inpatient and outpatient care and death certificates and were confirmed by medical record review. Results: 51 opioid-related overdoses were identified, including 6 deaths. Compared with patients receiving 1 to 20 mg/d of opioids (0.2% annual overdose rate), patients receiving 50 to 99 mg/d had a 3.7-fold increase in overdose risk (95% CI, 1.5 to 9.5) and a 0.7% annual overdose rate. Patients receiving 100 mg/d or more had an 8.9-fold increase in overdose risk (CI, 4.0 to 19.7) and a 1.8% annual overdose rate. Limitations: Increased overdose risk among patients receiving higher dose regimens may be due to confounding by patient differences and by use of opioids in ways not intended by prescribing physicians. The small number of overdoses in the study cohort is also a limitation. Conclusion: Patients receiving higher doses of prescribed opioids are at increased risk for overdose, which underscores the need for close supervision of these patients. Primary Funding Source: National Institute of Drug Abuse.
The Prevalence and Severity of Microvascular Complications in Pancreatic Diabetes and IDDM
Authors: Naomi S Levitt, Ganief Adams, John Salmon, I N Solly Marks, Gregory Musson, Charles Swanepoel, Margaret Levy, Michael J Byrne
Journal: Diabetes Care (1995)

OBJECTIVE To investigate and compare the prevalence, associations, and severity of retinopathy and nephropathy in patients with pancreatic diabetes (PD) and insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS Thirty patients with PD due to alcohol-induced chronic pancreatitis were matched for age, sex, and duration of diabetes with 30 patients with IDDM. Retinopathy was assessed by fluorescein angiography using the Wisconsin classification. Renal function was assessed by albumin excretion rates (AERs) in at least two timed overnight urine collections and glomerular filtration rates (GFRs) by single injection of 51Cr-EDTA. Microalbuminuria was defined as AER 20–200 μg/min and nephropathy as AER &amp;gt; 200 μg/min. RESULTS Retinopathy was found in 33% of patients with PD and in 40% with IDDM. The spectrum of disease was similar in the two groups. The geometric mean of AER was 15 μg/min (range 1–1,541) in the PD group and 24 μg/min (2–2,288) in the IDDM group. Nephropathy was found in 7 PD and in 5 IDDM patients, and a reduced GFR was present in 8 (26%) and 4 (13%) of the two groups, respectively. Microalbuminuria occurred in 9 (33%) and hyperfiltration in 3 (10%) in each group. These differences were insignificant. Retinopathy correlated with AER in both groups. Retinopathy and AER correlated with duration of diabetes in the IDDM but not in the PD group. CONCLUSIONS Microvascular complications are equally common and severe in PD and IDDM, and improved glycemic control should be the goal in both.
The truth hurts
Authors: L. Farrell
Journal: BMJ (2011)

The traditional consultation is a dinosaur; to be fit for purpose it must adapt to an ever changing world. But until now our hands have been tied because the doctor-patient relationship is unequal. Patients can blithely lie to our faces while we are expected to be honest and truthful; it’s like a medical dhimmitude. Well, I’m mad as hell, and I’m not gonna take it anymore.⇑

“Honestly, doc,” said Joe smugly, unaware of my new arrangements. “I don’t smoke.” …
‘Load me up, Scotty’: mechanotherapy for plantar fasciopathy (formerly known as plantar fasciitis)
Authors: M S Rathleff, K Thorborg
Journal: British Journal of Sports Medicine (2015)

Plantar heel pain is often caused by plantar fasciitis (fasciopathy) and treatment has traditionally included stretching, gel heel inserts and injections. However, in line with the increased clinical focus and evidence regarding mechanotherapy, as re-introduced by Khan and Scott,1 a novel approach was recently taken by Rathleff et al 2 using exercise and load (mechanotransduction) to treat the injured plantar fascia. The rationale for applying mechanotherapy was that plantar fascia consists of type 1 collagen and exhibits tendinopathy traits, including degenerative changes, deterioration of collagen fibres, increased secretion of ground substance proteins, focal areas of fibroblast proliferation and increased vascularity.3 ,4 

The new treatment of plantar fasciopathy consists of slow, high-load strength training and is comparable to plantar fascia-specific stretching among patients with plantar fasciopathy.2 The patients performed heel-raises using a towel underneath the toes to increase dorsiflexion of the metatarsophalangeal joints. Slow high-load strength training in addition to heel …
<i>Chlamydophila pneumoniae</i> and <i>Mycoplasma pneumoniae</i>
Authors: Sebastian L. Johnston, Richard J. Martin
Journal: American Journal of Respiratory and Critical Care Medicine (2005)

The potential role of atypical bacterial infection in the pathogenesis of asthma is a subject of continuing debate. There is an increasing body of literature concerning the association between the atypical bacteria Chlamydophila pneumoniae and Mycoplasma pneumoniae and asthma pathogenesis; however, many studies investigating such a link have been uncontrolled and have provided conflicting evidence, in part due to the difficulty in accurately diagnosing infection with these atypical pathogens. This article reviews the evidence for an association between atypical bacterial respiratory pathogens and the pathogenesis of asthma, and discusses the biological mechanisms that could account for such a link. The possible role of antibacterial therapy in the management of asthma and the need for well-designed studies to investigate this is also discussed.
PWE-007 Uptake of the Bowel Cancer Screening Programme in the Eastern Region of England: Trends by Age and Gender
Authors: A Field, M Vogler, R F Logan
Journal: Gut (2013)

<h3>Introduction</h3> Bowel cancer is more common in men than women with age-adjusted incidence in the UK being over 50%% higher in men and mortality 63% higher. However uptake of the Bowel Cancer Screening Programme in England (BCSP) has been generally about 5% lower in men<sup>1</sup>. We have examined whether with increasing familiarity with the BCSP there have been changes in uptake of screening invitations over the past 4 –5 years. <h3>Methods</h3> Analysis of uptake of screening invitations by sex and 2 year age bands of people invited for screening by the Eastern Hub which covers the East of England and East Midlands (total population 10.6 million) between 1 Jan 2008 and 30 June 2012 by 6 month periods. <h3>Results</h3> Over the 4.5 years &gt; 2.8 million invitations were sent by the Eastern Hub. For those aged 60–61 years uptake by men was 9–10% lower than that by women (uptake 60%) with no evidence of any change over the 4 years. In women uptake remained over 60% for the 62–63, 64–65 and 66–67 age bands with a small increase over time reaching 65% in 2012. In men uptake showed a steady increase with age such that by age 68–69 uptake was only 2–3% lower than in women. For those aged 70–71 uptake in men and women was generally similar and for those aged 72–73 and those aged 74 uptake was around 2% higher in men than women. This was partly accounted for by a decline in uptake in women to below 60%. Analysis of time trends in those over 70 was unreliable because of only partial roll-out (‘age extension’) of the BCSP to this group in the Eastern region. <h3>Conclusion</h3> While the small decline in uptake in women &gt; 70 years is a concern the increasing uptake in men with age is encouraging and suggests that the introduction of simpler screening approaches using faecal immunochemical tests will see substantial increses in uptake of the BCSP2. <h3>Disclosure of Interest</h3> None Declared. <h3>References</h3> Logan RF, Patnick J, Nickerson C,<i></i><i>et al.</i> Outcomes of the Bowel Cancer Screening Programme in England after the first 1 million tests. Gut 2012, vol 61, pp1439–46. van Rossum LG, van Rijn AF, Laheij RJ <i>et al.</i><i></i> Random comparison of guaiac and immunochemical faecal occult blood tests for colorectal cancer in a screening population Gastroenterology 2008 vol 135 pp82–90
Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude
Authors: R. Fischer, S.M. Lang, M. Leitl, M. Thiere, U. Steiner, R.M. Huber
Journal: European Respiratory Journal (2003)

A randomised, double-blind, placebo-controlled study was conducted to evaluate the effects of theophylline and acetazolamide in the treatment of sleep-disordered breathing (SDB) after fast ascent to high altitude (3,454 m). The study was conducted at a high-altitude research laboratory and included 30 healthy male volunteers. Study medication was either oral slow release theophylline (2×250 mg·day −1 ), oral acetazolamide (2×250 mg·day −1 ) or a matched placebo tablet. Polysomnographic measurements were performed during two consecutive nights, and acute mountain sickness, pulse rate, oxyhaemoglobin saturation and arterial blood gases were assessed three times a day. Without active medication, the apnoea/hypopnoea index (AHI) was highly pathological (median 16.2·h −1 , range 2–92). Both theophylline and acetazolamide normalised SDB (median AHI 2.5·h −1 , range 0–11; 4.2·h −1 , range 0–19, respectively) and reduced oxyhaemoglobin desaturations during sleep (median desaturation index placebo 41.5·h −1 , range 6–114; acetazolamide 6.5·h −1 , range 3–28; theophylline 8.5·h −1 , range 3–32). Compared with the high amount of central apnoeas or hypopnoeas, the number of obstructive events during sleep was very low in all groups (&lt;4·h −1 ). In contrast to theophylline, acetazolamide significantly improved basal oxyhaemoglobin saturation during sleep (86.2±1.7% versus 81.0±3.0%). The authors conclude that both oral slow release theophylline and acetazolamide are effective to normalise high-altitude sleep-disordered breathing.
Effects of transfusion with red cells filtered to remove leucocytes: randomised controlled trial in patients undergoing major surgery
Authors: Joost A van Hilten, Leo M G van de Watering, J Hajo van Bockel, Cornelis J H de Velde, Job Kievit, Ronald Brand, Wilbert B van den Hout, Robert H Geelkerken, Rudi M H Roumen, Ronald M J Wesselink, Ankie W M M Koopman-van Gemert, Jan Koning, Anneke Brand
Journal: BMJ (2004)

<h3>Abstract</h3> <b>Objective</b> To compare postoperative complications in patients undergoing major surgery who received non-filtered or filtered red blood cell transfusions. <b>Design</b> Prospective, randomised, double blinded trial. <b>Setting</b> 19 hospitals throughout the Netherlands (three university; 10 clinical; six general). <b>Participants</b> 1051 evaluable patients: 79 patients with ruptured aneurysm, 412 patients undergoing elective surgery for aneurysm, and 560 undergoing gastrointestinal surgery. <b>Interventions</b> The non-filtered products had the buffy coat removed and were plasma reduced. The filtered products had the buffy coat removed, were plasma reduced, and filtered before storage to remove leucocytes. <b>Main outcome measures</b> Mortality and duration of stay in intensive care. Secondary end points were occurrence of multi-organ failure, infections, and length of hospital stay. <b>Results</b> No significant differences were found in mortality (odds ratio for filtered <i>v</i> non-filtered 0.80, 95% confidence interval 0.53 to 1.21) and in mean stay in intensive care (- 0.4 day, - 1.6 to 0.6 day). In the filtered group the mean length of hospital stay was 2.4 days shorter (- 4.8 to 0.0 day; P = 0.050) and the incidence of multi-organ failure was 30% lower (odds ratio 0.70, 0.49 to 1.00; P = 0.050). There were no differences in rates of infection (0.98, 0.73 to 1.32). <b>Conclusion</b> The use of filtered transfusions in some types of major surgery may reduce the length of hospital stay and the incidence of postoperative multi-organ failure.
Role of Nitric Oxide in Angiogenesis and Tumor Progression in Head and Neck Cancer
Authors: Oreste Gallo, Isabella Fini-Storchi, William A. Vergari, Emanuela Masini, Lucia Morbidelli, Marina Ziche, Alessandro Franchi
Journal: JNCI Journal of the National Cancer Institute (1998)

Angiogenesis (formation of new blood vessels) is associated with tumor growth and metastasis in patients with solid tumors, including those of the head and neck. Nitric oxide (NO) production may contribute to these processes. We assessed the role of the NO pathway in angiogenesis and tumor progression in patients with head and neck cancer.Biochemical assays were used to measure NO synthase (NOS) activity and cyclic guanosine monophosphate (cGMP) levels in specimens of tumor and normal mucosa obtained from 27 patients. Microvessels in tumor specimens were identified by CD-31-specific immunohistochemical staining. Associations between microvessel densities, levels of NOS, and cGMP were examined by use of two-sided statistical tests. Tumor specimens and human squamous carcinoma A-431 cells were grown as explants on the corneas of rabbits, and the effect of the NOS inhibitor N(omega)-nitro-L-arginine-methyl ester (L-NAME) was tested.Levels of total NOS, inducible NOS, and cGMP were higher in tumor specimens than in specimens of normal mucosa (all P<.0001). Tumor specimens from patients with lymph node metastases presented a higher total NOS activity (P = .005) and were markedly more vascularized than tumor specimens from patients with no lymph node involvement (P = .0002). Microvessel density at the tumor edge was an independent predictor of metastasis for this series of patients (odds ratio = 1.19; 95% confidence interval = 1.07-2.89; P = .04). A-431 cells and tumor specimens exhibiting high levels of NOS activity induced angiogenesis in the rabbit cornea assay; when NO production was blocked, tumor angiogenesis and growth were repressed.The NO pathway appears to play a key role in tumor angiogenesis and spread in patients with head and neck cancer.
Telomerase Mutations in Families with Idiopathic Pulmonary Fibrosis
Authors: Mary Y. Armanios, Julian J.-L. Chen, Joy D. Cogan, Jonathan K. Alder, Roxann G. Ingersoll, Cheryl Markin, William E. Lawson, Mingyi Xie, Irma Vulto, John A. Phillips, Peter M. Lansdorp, Carol W. Greider, James E. Loyd
Journal: New England Journal of Medicine (2007)

Idiopathic pulmonary fibrosis is progressive and often fatal; causes of familial clustering of the disease are unknown. Germ-line mutations in the genes hTERT and hTR, encoding telomerase reverse transcriptase and telomerase RNA, respectively, cause autosomal dominant dyskeratosis congenita, a rare hereditary disorder associated with premature death from aplastic anemia and pulmonary fibrosis.To test the hypothesis that familial idiopathic pulmonary fibrosis may be caused by short telomeres, we screened 73 probands from the Vanderbilt Familial Pulmonary Fibrosis Registry for mutations in hTERT and hTR.Six probands (8%) had heterozygous mutations in hTERT or hTR; mutant telomerase resulted in short telomeres. Asymptomatic subjects with mutant telomerase also had short telomeres, suggesting that they may be at risk for the disease. We did not identify any of the classic features of dyskeratosis congenita in five of the six families.Mutations in the genes encoding telomerase components can appear as familial idiopathic pulmonary fibrosis. Our findings support the idea that pathways leading to telomere shortening are involved in the pathogenesis of this disease.
Data reduction for large scale cough studies using distribution of audio frequency content
Authors: Antony Barton, Patrick Gaydecki, Kimberley Holt, Jacky Smith
Journal: European Respiratory Journal (2011)

Background:  Recent studies have suggested that the objective quantification of coughing from sound recordings provides novel insights into the mechanisms underlying cough and the efficacy of therapies. However, reliable methods for minimisation of sound data are required to improve the feasibility of processing many and large patient data records for large scale studies of cough treatments for both manual and potential automatic cough counting.   Aim:  To determine if a developed system can identify periods of inactivity in sound recordings to significantly reduce record length without degrading data (i.e. inadvertent removal of cough sounds), referred to hereafter as destructiveness.   Methods:  Inactive periods of audio are identified by measuring the median audio frequency within small segments of recordings and removing those below a selected threshold. 200 randomly selected 15 minute periods known to contain cough, from 20 patients [healthy (5), COPD (5), asthma (5) and chronic cough (5); male (10)] were used, each recorded for 24hrs. To measure destructiveness, both the audio kept and removed by the algorithm were analysed by trained cough counters and compared to counts for the original files. Finally, the efficacy of the algorithm was determined by the reduction in record length achieved across all of the patient data.   Results:  The average resultant file size was 6.04% (54.4s) of the original (median 13.9s, iqr 56.4s) and the system erroneously removed 1.6% of coughs at a rate of 0.62 coughs h -1 .   Conclusions:  The system has shown to be reliable for use in cough monitoring as an excellent means of removing large sections of audio and profoundly improving the efficiency of manual cough counting.
Randomized Phase II Study of Vandetanib Alone or With Paclitaxel and Carboplatin as First-Line Treatment for Advanced Non–Small-Cell Lung Cancer
Authors: John V. Heymach, Luis Paz-Ares, Filippo De Braud, Martin Sebastian, David J. Stewart, Wilfried E.E. Eberhardt, Anantbhushan A. Ranade, Graham Cohen, Jose Manuel Trigo, Alan B. Sandler, Philip D. Bonomi, Roy S. Herbst, Annetta D. Krebs, James Vasselli, Bruce E. Johnson
Journal: Journal of Clinical Oncology (2008)

Vandetanib is a once-daily, oral inhibitor of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling. The antitumor activity of vandetanib monotherapy or vandetanib with paclitaxel and carboplatin (VPC) was compared with paclitaxel and carboplatin (PC) in previously untreated patients with non-small-cell lung cancer (NSCLC).All NSCLC histologies and previously treated CNS metastases were permitted in this partially blinded, placebo-controlled, randomized phase II study. Patients were randomly assigned 2:1:1 to receive vandetanib, VPC, or PC. Progression-free survival (PFS) was the primary end point, and the study was powered to detect a reduced risk of progression with VPC versus PC (hazard ratio = 0.70; one-sided P < .2) and to demonstrate noninferiority for vandetanib versus PC. Overall survival was a secondary assessment.The risk of progression was reduced for patients receiving VPC (n = 56) versus PC (n = 52; hazard ratio = 0.76, one-sided P = .098); median PFS was 24 weeks (VPC) and 23 weeks (PC). The vandetanib monotherapy arm (n = 73) was discontinued after a planned interim PFS analysis met the criterion for discontinuation (hazard ratio > 1.33 v PC). Overall survival was not significantly different between patients receiving VPC or PC. Rash, diarrhea, and hypertension were common adverse events; no pulmonary or CNS hemorrhage events required intervention.VPC could be safely administered to patients with NSCLC, including those with squamous cell histology and treated brain metastases. Compared with the PC control arm, patients receiving VPC had longer PFS, meeting the prespecified study end point, whereas those receiving vandetanib monotherapy had shorter PFS.
Physical inactivity is a risk factor for physical activity-related injuries in children
Authors: Frank Bloemers, Dorine Collard, Mai Chin A Paw, Willem Van Mechelen, Jos Twisk, Evert Verhagen
Journal: British Journal of Sports Medicine (2011)

Objectives To describe the risk factors associated with injuries resulting from physical education (PE), leisure time physical activity (leisure time PA) and sports in 9–12-year-old children. Design Prospective cohort study. Setting Primary schools. Participants Nine hundred and ninety-five children aged 9–12 years. Main outcome measures Injuries occurring during either PE class, leisure time PA or sports, and caused the child to at least stop the current activity were recorded prospectively. Individual weekly exposure was estimated from baseline and follow-up questionnaires. Potential risk factors were gender, age, socioeconomic status, ethnicity, habitual level of PA, body mass index and a motor fitness. A multivariate Cox proportional hazard regression model was developed, accounting for clustering within schools. Results Gender, age and level of PA were independent significant risk factors for injury. Different modalities of PA had different injury risk factors. Most importantly, the low levels of habitual PA significantly increased injury risk. Conclusions The children at highest injury risk are the target audience of the contemporary PA promotion efforts. PA promotion should also focus on injury prevention.
Interactions of conjugated linoleic acid and lipoic acid on insulin action in the obese Zucker rat
Authors: Mary K Teachey, Zachary C Taylor, Thomas Maier, Vitoon Saengsirisuwan, Julie A Sloniger, Stephan Jacob, Martin J Klatt, Arne Ptock, Klaus Kraemer, Oliver Hasselwander, Erik J Henriksen
Journal: Metabolism (2003)
Stable and strong expression of basic fibroblast growth factor in naevus cell naevus contrasts with aberrant expression in melanoma
Authors: M. UEDA, Y. FUNASAKA, M. ICHIHASHI, Y. MISHIMA
Journal: British Journal of Dermatology (1994)

It has been proposed that basic fibroblast growth factor (bFGF) is an autocrine growth factor of melanoma cells, in contrast with normal melanocytes where bFGF acts as a paracrine growth factor. As this notion is mostly based on the different requirements for bFGF in cultures of benign and malignant pigment cells in vitro, we performed an immunohistochemical study to examine bFGF expression in vivo using paraffin sections from naevus cell naevi (NCN) and malignant melanoma (MM). All the NCN (n=7) showed strong and homogeneous expression of bFGF protein, whereas the primary MMs (n=5) showed heterogeneous expression, with a population of negative cells. Metastatic MMs (n=5) also showed heterogeneous expression, and had a greater population of negative cells. These results suggest that bFGF has some, as yet unidentitied, role in the growth of benign NCN, and that overexpression of bFGF is neither a prerequisite for melanoma genesis nor for progression to metastatic MM.