Kornimate/medical-research-clean huggingface dataset:
study of nilotinib in ph+ cml-cp patients with low imatinib trough plasma concentrations

Conditions: CML; Philadelphia Chromosome Positive (Ph+); Chronic Myelogenous Leukemia Chronic Phase(CML-CP) Patients With Low Imatinib Trough Levels

Summary: this study is to determine the number of european leukemia network (eln)guideline defined treatment failure events from time of study entry in cml-cp patients with low imatinib trough concentrations treated with nilotinib.


Eligibility criteria:
inclusion criteria: * cytogenetically confirmed ph+ cml-cp any prior dose of imatinib * imatinib 400 mg daily for ≥7 consecutive days prior to imatinib trough collection * imatinib trough plasma concentration \<850 ng/ml exclusion criteria: * prior documented failure events as defined by eln guidelines: * loss of chr, ccyr, or clonal progression/ph+ * less than chr at 3 months after diagnosis * no cyr at 6 months after diagnosis * less than pcyr at 12 months after diagnosis * less than ccyr at 18 months after diagnosis * prior accelerated phase or blast phase cml * previously documented t315i mutation * previous treatment for cml with any other tyrosine kinase inhibitor except for imatinib * patients who had any other treatment for cml (transplant) except interferon +/- ara- c, imatinib, hydroxyurea and/or anagrelide * impaired cardiac function * patients receiving therapy with strong inhibitors of cyp3a4 or medications that prolong the qt interval and cannot be either discontinued or switched to a different medication prior to starting study drug. * any other malignancy that is clinically significant or requires active intervention. * major surgery within 4 weeks prior to day 1 of study or who have not recovered from prior surgery * treatment with other investigational agents within 30 days of day 1 * women who are pregnant, breast feeding, or of childbearing potential without a negative serum test at baseline. post-menopausal women must be amenorrhoeic for at least 12 months to be considered of non-childbearing potential. women of childbearing potential must have a negative serum pregnancy test within 7 days of the first dose of nilotinib * sexually active male and female patients taking nilotinib unwilling to use adequate contraception throughout the trial and 3 months following discontinuation of study drug

Keywords: philadelphia chromosome positive ph+ chronic myelogenous leukemia chronic phase cml-cp low imatinib trough levels
transcranial magnetic stimulation for treatment of insomnia

Conditions: Insomnia

Summary: transcranial magnetic stimulation (tms) is a non-invasive brain stimulation technique that has been approved as a treatment of depression in patients that have not responded to a trial of one antidepressant medication. the investigators hypothesize that low frequency tms exerts inhibitory effect on hyper excitable cortical state in patients with chronic insomnia and therefore is therapeutic. the investigators want to compare the change in insomnia scores between baseline and end of treatment in an open label trial with bifrontal low frequency tms stimulation in 20 patients with primary insomnia using daily stimulation of 3 weeks (15 week days).

insomnia is a common clinical problem that affects about 25 million people in the us. insomnia exacts health and economic consequences well beyond inadequate and non-restorative sleep. it increases healthcare costs, causes or adds to medical and psychiatric comorbidities, cognitive impairments, accidents, absenteeism and reduced quality of life. treatment of insomnia is difficult and usually needs a multimodal approach incorporating various cognitive and behavioral approaches in addition to medication treatment. tms and other neurophysiological studies have shown presence of a diffuse cortical hyper-arousal in patients with chronic insomnia. high frequency tms (\>1 hz) has been shown to be activating whereas low frequency tms (\<1hz) has been shown to be inhibitory in clinical and neurophysiological studies. tms has been approved as a treatment of depression in patients who have not responded to a trial of at least one antidepressant medication. the goal of this study is to translate the knowledge learned from neurophysiological studies of insomnia to the clinical treatment of insomnia using tms as the primary modality. aim: compare the change in insomnia scores between baseline and end of treatment with bifrontal low frequency tms stimulation in 20 patients with primary insomnia using daily stimulation of 3 weeks (15 week days).

Eligibility criteria:
inclusion criteria: 1. patients referred for evaluation and management of insomnia to our sleep disorders clinic will be offered enrollment in this study 2. patients must meet diagnostic and statistical manual (dsm) iv criteria for primary insomnia 3. aged 21-65 years to target relatively healthy adults exclusion criteria: 1. patients with co-morbid depression 2. substance abuse in last two weeks 3. no psychotropic medication changes 2 weeks before start of tms treatment and no changes during the 3 week treatment period 4. patients with a major medical or psychiatric disorder that may be causing or contributing to insomnia: bipolar disorder, psychosis, anxiety disorders, dementia, seizure disorder and chronic pain 5. patients with ferromagnetic material in their head or within 30 cm of the coil will be excluded

Keywords: insomnia
surveillance of high-risk early postsurgical patients for real-time detection of complications

Conditions: Complication, Postoperative

Summary: the aim of this study is to test the hypothesis that continuous wireless monitoring on the postsurgical ward will improve patient outcome, measured as disability-free survival at three months after surgery. further, the investigators hypothesize that this tight control regimen decreases length of hospital stay and treatment costs in patients with complications.

every year, approximately 1,500,000 surgical procedures are performed in the netherlands alone. after major surgery, the complication rate is conservatively estimated at 25%, with a rate of 15% for major complications. in these patients, the most important problems are a failure to timely detect developing complications and a failure to adequately rescue those patients. currently, measurement of vital signs and standardized assessment of patient wellbeing are routinely performed intermittently for every 8-12 hours, which may lead to a failure to detect of patients with complications. the aim of this study is to test the hypothesis that continuous wireless monitoring on the postsurgical ward will improve patient outcome, measured as disability-free survival at three months after surgery. further, the investigators hypothesize that this tight control regimen decreases length of hospital stay and treatment costs in patients with complications. the investigators will carry out this study as an interventional, randomized (per surgical ward), prospective, clinical trial; participating wards will be included using a stepped-wedge design. primary outcome is disability-free survival at three months after surgery.

Eligibility criteria:
inclusion criteria: * adult patients undergoing acute or elective major or intermediate surgery * american society of anesthesiology (asa) score of i to iv exclusion criteria: * inability to give written and informed consent * refusal to participate
intraoperative hyaluronic acid gel injection for improvement of scar quality following reduction mammaplasty

Conditions: Cicatrix

Summary: the purpose of this study is to determine the efficacy of hyaluronic acid gel injections compared to saline injections in improving scar quality in patients undergoing breast reduction surgery. hyaluronic acid has been implicated in scarless fetal healing, and the investigators therefore hypothesize that injections of hyaluronic acid gel into breast reduction incisions will improve their appearance compared to injections of saline.


Eligibility criteria:
inclusion criteria: * adequate organ function (bun \ 100 g/l; wbc \> 4,000/mm3 and \ 100,000/mm3) * age 18 years or older, with a minimum life expectancy of 2 years * current non-smoker * american society of anaesthesiology score of 1 or 2 * ability to provide informed consent exclusion criteria: * previous history of breast surgery; known allergy to polyglactin, poliglecaprone, or injectable hyaluronic acid gel (restylane or prevelle) * history of current or recent (\<2 months) immunosuppression * documented hypersensitivity to streptococcal products * acute or chronic skin diseases such as folliculitis or psoriasis * history of bleeding dyscrasia or active anticoagulation (inr\>2.0) * pregnancy or active breast-feeding * any additional surgical procedures performed in the same surgical session in the same anatomical region * personal or family history of susceptibility to keloid or hypertrophic scar formation * fitzpatrick skin type 5 or 6.
scientific rationale and design for a prospective study to codify coronary lesions based on fluid mechanics and acoustic mechanisms

Conditions: Unstable Angina (UA)

Summary: from january 2020 to june 2025, patients coming to the cardiac catheterization laboratories (ccl) for out-patient coronary angiography with diagnosis of unstable angina were screened for inclusion. patients were included in the study if they had previously undergone one or more coronary angiograms, allowing for a longitudinal comparison of dynamic flow and phenomena between the two or more angiograms.

patients with history of prior percutaneous coronary intervention (pci), coronary artery bypass graft surgery (cabg) were excluded. the aortic stenosis patients were also excluded if they had end-stage disease with survival time \<6 months or if they had other severe hemodynamic disturbances such as hypotension from non-cardiac problems (sepsis, bleeding, etc).

Eligibility criteria:
inclusion criteria: patients were included in the study if they had one or two lesions in coronary angiograms. - exclusion criteria: patients with history of prior percutaneous coronary intervention (pci), coronary artery bypass graft surgery (cabg) were excluded. -
improving cardiac arrest diagnostic accuracy of emergency medical dispatchers

Conditions: Cardiac Arrest

Summary: the main goal of this project is to help 9-1-1 emergency medical dispatchers save the lives of more cardiac arrest victims. the investigators will develop teaching tools to help the dispatchers recognize abnormal breathing that may indicate a victim as having a cardiac arrest. after training sessions, the investigators will see if dispatchers can get better at recognizing abnormal breathing, how often they give cpr instructions, and if use of the teaching tool will increase bystander cpr and the number of victims leaving the hospital alive.

cardiac arrest is a leading cause of death in canada; it is defined as the sudden cessation of cardiac mechanical activity. it is uniformly fatal if not treated within minutes. more than 85% of out-of-hospital cardiac arrest (oohca) occur in residential locations so public access to automatic external defibrillators, to restart the heart, are not helpful. the overall rate of survival for oohca rarely exceeds 8%. bystander cardiopulmonary resuscitation (cpr) is chest compression and ventilations provided by someone not on the emergency response team. a victim or cardiac arrest is almost 4 times more likely to survive when receiving bystander cpr. however, despite various attempts to improve bystander rates they have remained low, not exceeding 15% in ontario. it has been shown that since the ambulance dispatch centres in ontario implemented dispatch-assisted cpr instructions (given to callers while emergency vehicles were on the way), there was a significant increase in use. emergency medical dispatchers can identify about 70% of oohca cases over the phone. agonal breathing (laboured breathing preceding death) may be misinterpreted as a sign of life, and is responsible for as much as 50% of missed diagnoses. there is no specific training on the significance of this sign, and minimal information about recognizing cardiac arrest. an educational intervention designed to better understand the significance of agonal breathing and to clarify the existing cpr instruction protocol will most likely increase the frequency of cpr instructions, bystander cpr rates, and potentially survival of victims of cardiac arrest.

Eligibility criteria:
inclusion criteria: * presumed cardiac origin * event occurs in the catchment area of training or control site * resuscitation is attempted by a bystander and/or the emergency responders exclusion criteria: * patients younger than 16 years old * patients who are "obviously dead" as defined by the ambulance act of ontario (decomposition, rigor mortis, decapitation, or other) * trauma victims including hanging and burns * cardiac arrest of non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident, and documented terminal illness

Keywords: cardiac arrest bystander cardiopulmonary resuscitation cpr dispatch-assisted cpr instructions agonal breathing
comparison of surgical methods on resistant sites in stable vitiligo patients

Conditions: Vitiligo

Summary: comparing the efficacy of three different surgical methods on resistant sites in stable vitiligo.

the treatment of vitiligo includes both medical and surgical modalities, whose goal is to restore melanocytes to the depigmented skin so that the epidermis restores back to normal morphology and functions. although medical treatment is the main stay of treatment, it is not effective in all and residual lesions need augmented surgical treatment later for further completion of repigmentation. now a day surgical modalities have become treatment of choice for stable vitiligo not responding to medical treatment although there are numerous sites which do not respond that well to surgical procedure as well. the investigators ought to compare the efficacy of 3 well established surgical methods i.e. mini punch grafting vs suction blister epidermal grafting vs non cultured epidermal cell suspension on stable vitiligo patches localized to acral areas and bony prominences like elbows, knees and ankles. out of all the vitiligo patches in a given participant, 3 different patches on acral and bony areas will be chosen and participants will be treated with 3 different methods.

Eligibility criteria:
inclusion criteria: 1. subjects with clinical diagnosis of focal, segmental or generalized vitiligo 2. patients with lesions of size \> 1.5cm x 1cm present on acral areas and bony prominences. 3. vitiligo lesions has been stable for 1 year. 4. disease not responding to medical treatment, or there are residual patches (after medical therapy) of vitiligo which inturn are located on acral areas and bony prominences. 5. maximum size of vitiligo patches to be selected for surgery will not be \>100cm2. exclusion criteria: 1. age less than 18 years 2. pregnancy and lactation 3. patient with actively spreading vitiligo 4. history of koebnerisation 5. history of hypertrophic scars or keloidal tendency 6. bleeding disorders 7. patients with unrealistic expectation

Keywords: acral
endometrial biopsy instrument comparison study

Conditions: Pain

Summary: the purpose of this study is to determine the level of pain women experience during an endometrial biopsy and the effect that the biopsy tool might have on that pain. the investigators will also evaluate the adequacy of the sample each endometrial biopsy tool collects.

is there a difference in pain perceived by patients undergoing endometrial biopsy via the pipelle or explora curette? currently, the instrument selected for endometrial biopsy is solely dependent on provider preference. this study aims to elucidate advantages and/or disadvantages of the pipelle versus the explora curette in terms of pain perceived by the patient, adequacy of sample, and provider ease of use to better aid in the selection of the appropriate device.

Eligibility criteria:
inclusion criteria: * women ages 18 and over who present to the oregon health and science university center for women's health and the portland veteran's affairs medical center with an indication for endometrial biopsy, are literate in english or spanish, who are willing to participate in the study. exclusion criteria: * pregnancy, known or suspected * known cervical stenosis * history of mullerian tract anomalies * history of uterine or cervical surgery * pelvic inflammatory disease (current or within the past 3 months) * sexually transmitted diseases (current) * puerperal or post abortion sepsis (current or within the past 3 months) * purulent cervicitis (current) * known clotting disorder * known uterine anomalies or fibroids distorting the cavity in a way incompatible with office endometrial biopsy * allergy to any component of the pipelle or explora curette * patients who are premedicated with analgesics or misoprostol * patients who require mechanical cervical dilation or receive paracervical block

Keywords: endometrial biopsy pain management
transradial and transfemoral coronary angiography by experienced operators

Conditions: Exposure to Ionizing Radiation; Coronary Heart Disease; Vascular Access Complication

Summary: transradial approach (tra) reduces vascular complications and access related-bleeding compared to transfemoral approach (tfa). however, this technique has been related to higher radiation exposure during coronary angiography and percutaneous coronary intervention. previous studies have shown that tra demands a long learning curve, and procedure success rate increases with operator's experience. our hypothesis is that the higher radiation exposure during tra is not a technique issue, but due to operator's expertise. the aim of this study is to evaluate whether experienced operators with either tra or tfa can perform diagnostic coronary angiography with similar radiation exposure.


Eligibility criteria:
inclusion criteria: * indication for a elective coronary angiography * eligible for either transfemoral or transradial approach * accept to sign the written consent form (wcf) exclusion criteria: * refusal to sign the wcf * end stage renal failure * urgency/emergency procedure * contraindication to perform both coronary and left ventricle angiogram * necessity of another vascular angiogram during coronary angiography

Keywords: occupational radiation exposure transradial approach transfemoral approach
a comparison of multidetector ct and te in the diagnosis of congenital cyanotic heart diseases

Conditions: Congenital Heart Disease

Summary: multi-detector computed tomography angiography (mdcta) provides high-resolution images of the heart and its vasculature, allowing for accurate anatomical assessment, detection of complex cardiac morphology,

evaluation of coronary artery anatomy, and identification of extracardiac anomalies including the coronaries, pulmonary arteries, aorta, and pulmonary or systemic veins, and it delineates vessel walls and also displays the airway, mediastinal abnormalities, and pulmonary parenchyma by using contrast media. this modality is particularly useful for evaluating complex cardiac anatomy and identifying potential surgical or interventional targets.

Eligibility criteria:
inclusion criteria: * age above 18 and less than 65. * having congenital cyanotic heart diseases exclusion criteria: * heart surgery * other heart issues * not consented
ideal initial bolus and infusion rate for erector spinae plane block catheters

Conditions: Pain, Postoperative; Pain, Chest

Summary: this study would like to identify the best starting dose and infusion rate for nerve blocks and nerve catheters related to the erector spinae plane block that can improve functional status and pain control on cardiac surgery patients and minimize the necessity for opioid pain control using a continuous reassessment model.

the study will continue taking steps in helping to identify the role erector spinae plane nerve blocks have in thoracic surgery. this is a relatively new nerve block (first identified and described in 2016) and the studies that have been done and the case series that have been reported have been very promising in supporting its role in thoracic surgery. as it is a plane block (not around a specific nerve but in a general area), larger volumes and doses often have to be used in these sorts of blocks (such as a transverses abdominalis plane block) to get good spread of the local anesthetic in the plane to reach the desired nerves that pass through this plane with one injection. our hospital has been doing these blocks for patients as a standard of care for them, but this study will take a closer look to see if there is an optimal dose and volume of medicine to improve patients' functional status and pain control to minimize the need for opioids. the study will use a continuous reassessment model to determine the optimal dose.

Eligibility criteria:
inclusion criteria: * patients undergoing planned thoracotomies and sternotomies for cardiothoracic surgery who will be taken to the cardiac surgery icu postoperatively exclusion criteria: * bmi \>40 * infection at the proposed catheter site * ongoing sepsis/bacteremia * patient unable to sit up for the procedure * patients requiring significant vasopressor support (\>1 vasopressor) * patient refusal * less than 18 years of age (they are managed in the pediatric icu rather than the cardiac surgery icu)

Keywords: erector spinae cardiac surgery regional anesthesia
breath analysis in lung fibrosis

Conditions: Idiopathic Lung Fibrosis; Idiopathic Pulmonary Fibrosis

Summary: the aim of the study is to answer the question whether a disease specific profile of breath in patients with idiopathic lung fibrosis can be detected by an untargeted metabolomic study using exhaled breath analysis by mass spectrometry.


Eligibility criteria:
inclusion criteria: 1. clinical symptoms consistent with ipf 2. age 40 through 80 years 3. diagnosis of uip or ipf by hrct and surgical lung biopsy as outlined in table 1. only patients fulfilling the category "yes" will be included in the study. 4. extent of fibrotic changes (honeycombing, reticular changes) greater than extent of emphysema on hrct scan 5. no features supporting an alternative diagnosis exclusion criteria: 1. acute exacerbation within the last 6 weeks. 2. any relevant lung disease other than pulmonary fibrosis. 3. acute inflammatory disease (e.g. common cold) within the last 6 weeks. 4. acute or chronic hepatic disease. 5. renal failure or renal replacement therapy.

Keywords: mass spectrometry exhaled breath analysis