Kornimate/medical-research-clean huggingface dataset:
pulmonary function changes and diaphragmatic paralysis following ultrasound guided supraclavicular brachial plexus blockade: the effects of decreased local anesthetic volume

Conditions: Diaphragmatic Function; Lung Function

Summary: this clinical trial is being conducted to study lung function and movement of the major muscle involved in breathing (the diaphragm) after a brachial plexus nerve block (nerve "freezing"). the purpose of this study is to find out what effects (good and bad) ultrasound guided nerve freezing has on the movement of the patient's diaphragm and their lung function. the potential advantage of ultrasound guidance will be a lesser chance of freezing the nerves that innervate the diaphragm and thus having less of an effect on lung function.

the supraclavicular approach to brachial plexus blockade was first described by kulenkampf in 1911. with classic "blind" techniques, an incidence of pneumothorax has been reported ranging from 0.5-6.0%, limiting its widespread use, despite the belief that the supraclavicular approach is the most consistent, effective technique for anesthetizing the brachial plexus. with the advent of ultrasound guidance and real time visualization this risk has been minimized and a resurgence in utilization of this approach has occurred. increased block success, diminished performance times, and lower anesthetic volumes have been observed with this technique when compared to nerve stimulator techniques. despite these advantages, brachial plexus anesthesia above the clavicle is associated with diaphragmatic dysfunction and caution must be demonstrated in patients with respiratory disease. interscalene brachial plexus blockade has been widely documented to produce a 100% incidence of hemidiaphragmatic paresis and an associated 25% mean reduction in forced vital capacity (fvc) with local anesthetic volumes ranging from 20 - 45ml 8-10, these parameters for supraclavicular brachial plexus blockage are not as well defined. previous investigations report an incidence of hemidiaphragmatic paresis of 1-75% with supraclavicular brachial plexus blockade. this study will address whether diaphragmatic function and respiratory mechanics can be preserved with lower anesthetic volumes in ultrasound guided supraclavicular brachial plexus blockade.

Eligibility criteria:
inclusion criteria: * eligible patients undergoing supraclavicular blockade exclusion criteria: * \< 18 years of age, * mental illness precluding informed consent, * infection at the injection site, * coagulopathy, * allergy to local anesthetics, * inability to comprehend english, * pulmonary disease, and * pregnancy

Keywords: measurement of lung mechanics (fev1, fvc and pef)
benefits of extracorporeal shockwave therapy to reduce spasticity in stroke/cp

Conditions: Stroke, Cerebral

Summary: this study will help to explain us that extracorporealshockwave therapy can reduce spasticity in stroke patient,help them to restore their abilities and rom.therapy reduces dependency rate of patient.also seen this therapy shows reduction in spasticity of cp child population.improving the motor recovery.

eswt therapy increses molecular and immunological reactions,increase blood microcirculation and neurovascularization.it enhancing the neural proliferation of neural stem cell(nsc),which shows repair in brain function in cns diseases.extracorporeal shockwave can produce nitric oxide in enzymatic and non enzymatic way which help, to reduce muscle spasm.extracorporeal shockwave reduce the exitibilty of motor neuron by vibratory stimulation of tendon and reduces tension.after 2 weeks eswt muscle tension reduces increases range of motion reduces the pain.shock wave therapy appears to be effective in reducing spasticity levels irrespective of the age of the participants, the type of injury, and the tool used to measure the effect.eswt change in motor neuron exitibilty \& also associated with the spastic muscle.

Eligibility criteria:
inclusion criteria: * 3rd stage of stroke exclusion criteria: * non spastic cp,1st stage of stroke,spasticity caused by injury,newborn
a pilot study of demand valve oxygen inhalation therapy for cluster headache

Conditions: Cluster Headache

Summary: cluster headache is a disorder marked by frequent attacks of short-lasting, severe, unilateral head pain with associated autonomic symptoms. it is the most severe head pain syndrome known. currently, the two most common treatments for cluster headaches are inhaled oxygen and injectable sumatriptan. these treatments do not work for all cluster headache patients, and patients who smoke may eventually develop contraindication to triptans. new treatment options are needed. an alternative method of oxygen delivery (as opposed to continuous flow) uses a demand valve that is controlled by respiration rate, allowing increased oxygen flow in response to increased demand. this system may be more efficacious at stopping a cluster headache attack than the currently prescribed oxygen delivery system. this study will compare the effectiveness of oxygen delivered via demand valve versus continuous high flow oxygen via non-rebreather face mask in the acute treatment of a cluster headache attack. all patients will treat one cluster headache with each of the 2 treatment methods.

cluster headache is a primary headache disorder marked by frequent attacks of short-lasting, severe, unilateral head pain with associated autonomic symptoms. the goal of acute therapy for cluster headache is fast, effective and consistent relief. in the currently recommended dosing strategy of continuous flow 100% oxygen given via a non-rebreather face mask at 7-15l/min, the time to improvement can sometimes take upwards of 20-30 minutes and is not effective for all cluster headache sufferers. an alternative method of oxygen delivery (versus continuous flow) uses a demand valve which is controlled by the respiration rate, allowing increased oxygen flow in response to increased demand. this delivery system may be better at stopping a cluster headache attack than the continuous flow model as it can support hyperventilation which can enhance cerebral arterial vasoconstriction via a state of hyperoxia and hypocapnia. arterial vasoconstriction is one hypothesized method by which oxygen can abort a cluster headache attack. this proof of concept trial will evaluate if oxygen delivered via demand valve with a specific breathing technique is effective as a cluster headache acute treatment and is more effective than the traditional continuous high flow oxygen treatment with a non-rebreather face mask.

Eligibility criteria:
inclusion criteria: * men or women 18 to 65 with history of moderate severe or very severe cluster headaches and currently in a cluster headache period or cycle are included. exclusion criteria: * subjects who have a history of chronic obstructive lung disease, those who have major neurologic disorders other than cluster headaches, those with a history of syncope, or lightheadedness with hyperventilation and pregnant women are excluded.

Keywords: headache cluster headache oxygen therapy
goal directed hemodynamic therapy based on noninvasive monitoring in patients with hip fracture

Conditions: Hip Fractures

Summary: crude incidence rate in spain of hip fracture in people over 65 years was 511 cases per 100,000 in 2002. about 30% of patients die in the first year. cardiocirculatory complications during and after surgery partly explain this high morbidity and mortality. most patients are frail and with multicomorbidity. goal-directed hemodynamic therapy (gdt) based on noninvasive continuous monitoring of blood pressure, heart rate, oxygen saturation, cardiac output, cardiac index, stroke volume and stroke volume index can reduce perioperative complications and improve survival. the objective of our study is to assess the efficacy of a goal-directed hemodynamic therapy in reducing perioperative complications. patients and methods: non-randomized intervention study with a historical control and 1-year follow-up. patients older than 64 years with non-traumatic hip fracture requiring surgical intervention. in the control group standard care was performed based on non-invasive, intermittent arterial pressure measurement, obtained every 5 minutes, continuous heart rate, and oxygen saturation. in the intervention group gdt based on noninvasive monitoring will be performed. the main outcome will be the percentage of patients with perioperative complications. secondary outcomes: los and survival at 12 months of surgery.


Eligibility criteria:
inclusion criteria: * hip fracture that require surgical treatment * agree to participate and sign informed consent exclusion criteria: * pathological or traffic related fractures * anesthetic contraindication for surgery * refractures * contraindication for hemodynamic monitoring * physiocal less than 30 after 7 minutes * psychomotor agitation that prevents hemodynamic monitoring

Keywords: fluid therapy aged perioperative complications survival intraoperative goal directed therapy
occurrence of radiation-induced otitis media in nasopharyngeal carcinoma patients after intensity modulated radiotherapy

Conditions: Nasopharyngeal Carcinoma

Summary: this is an observational cohort study to investigate the incidence of radiation-induced otitis media, changes in tubal function and hearing in newly diagnosed nasopharyngeal carcinoma patients without metastasis at multiple time points from baseline to 1 year after radiotherapy.

patients with newly diagnosed non-metastatic nasopharyngeal carcinoma (ajcc 8th) will be recruited. the incidence of radiation-induced otitis media, eustachian tube function and hearing level in nasopharyngeal carcinoma patients will be prospectively evaluated by magnetic resonance imaging, otoscope, pure tone audiometry, acoustic immittance test and the eustachian tube dysfunction questionnaire (etdq-7) before treatment and serially up to 1 year after radiotherapy. the quality of life of patients will be evaluated before treatment and serially up to 1 year after radiotherapy. the incidence of radiation-induced otitis media, the changes of eustachian tube function and hearing level, together with the influencing factors, in nasopharyngeal carcinoma patients after induction chemotherapy and concurrent chemoradiotherapy will be investigated.

Eligibility criteria:
inclusion criteria: * age 18-70, regardless of sex. * ecog (eastern cooperative oncology group) score: 0-1. * patients must sign informed consent and be willing, and well understood the objective and procedure of this study. * patients with newly histologically confirmed non-keratinizing nasopharyngeal carcinoma, type of who ii or iii, clinical stage i-iva (according to the 8th american joint committee on cancer \[ajcc\] edition. * no radiotherapy or chemotherapy was administered before enrollment. * expected survival time ≥ 6 months. exclusion criteria: * women in pregnancy or lactation. * patients with significantly lower heart, liver, lung, kidney, bone marrow function and other severe medical condition. * prior to radiotherapy, there is a clear underlying disease of the eustachian tube or other ear diseases. * patients with otitis media before radiotherapy and have no improvement at the end of radiotherapy. * patients with history of middle ear, nasal or nasopharyngeal surgery on the affected side. * patients combined with congenital cleft palate and other craniofacial abnormalities. * patients with histologically confirmed keratinizing nasopharyngeal carcinoma, type of who i. * patients with recurrence and distant metastasis. * patients with radiotherapy or chemotherapy before. * age \ 70. * patients who changed their initial treatment regimen during the observation period due to disease progression (including tumor residual after radiotherapy, tumor recurrence, and new distant metastases).

Keywords: nasopharyngeal carcinoma radiation-induced otitis media
the effect of memantine on functional outcomes and motor neuron degeneration in amyotrophic lateral sclerosis (als)

Conditions: Amyotrophic Lateral Sclerosis

Summary: the purpose of the study is to investigate the effects of memantine in als patients using functional outcome measures.


Eligibility criteria:
inclusion criteria: * el escorial classification of laboratory supported probable, probable,or definite als * age 18 - 80 years, * als symptoms for no more than 3 years, * fvc greater than or equal to 60% predicted, * riluzole naïve or have been on a stable dose of riluzole for at least 2 months, * patients must have the ability to attend monthly study visits in edmonton or calgary, alberta exclusion criteria: * presence of significant sensory abnormalities, dementia, other neurologic diseases, uncompensated medical illness and psychiatric illness * female patients who are breastfeeding * use of concurrent investigational drugs, * patient unlikely to comply with study requirements * poor adherence to study protocol during run-in phase

Keywords: amyotrophic lateral sclerosis als motor neuron disease mnd memantine
efficacy and safety of etanercept 50 mg once weekly plus as needed topical agent in moderate to severe plaque psoriasis

Conditions: Psoriasis

Summary: to estimate the difference in effectiveness between treatment with etanercept 50 mg twice weekly (biw) and treatment with etanercept 50 mg once weekly (qw) plus an as needed (prn) topical agent for 12 weeks in adults with moderate to severe plaque psoriasis.

the recommended starting dose of etanercept for adult plaque psoriasis patients is a 50 mg dose given twice a week (biw) for 3 months followed by a reduction to a maintenance dose of 50 mg once weekly (qw). while most patients with moderate to severe plaque psoriasis are managed satisfactorily on etanercept monotherapy, a proportion may require a modified or alternative treatment regimen (eg, to handle flares or loss of effect) at some point during their chronic management. despite the clinical need, no published data from randomized controlled studies are currently available that demonstrate efficacy and safety of combined etanercept-based regimens in patients with plaque psoriasis. the addition of an as-needed topical medication to the step-down dose of etanercept 50 mg once weekly administered after the initial 12 week period of 50 mg twice weekly may be a potential option for patients who may require adjunctive therapy. this study aimed to provide data on this treatment option by estimating the difference in mean percent change in psoriasis area and severity index (pasi) scores between step-down etanercept 50 mg once weekly supplemented with as-needed topical medication and continuous treatment with etanercept 50 mg twice weekly. eligible patients will be enrolled in the study and will receive etanercept 50 mg twice weekly for 12 weeks. after 12 weeks of etanercept treatment, participants will be randomized in a 1:1 ratio to 1 of 2 treatment groups.

Eligibility criteria:
inclusion criteria: * has had stable moderate to severe plaque psoriasis for at least 6 months (eg, no morphology changes or significant flares of disease activity in the opinion of the investigator). * has a body surface area (bsa) involvement ≥ 10% and psoriasis area and severity index (pasi) ≥ 10 at screening and at baseline. * is a candidate for systemic therapy or phototherapy in the opinion of the investigator. * other inclusion criteria may apply. exclusion criteria: * has active guttate, erythrodermic, or pustular psoriasis at the time of the screening visit. * has evidence of skin conditions at the time of the screening visit (eg, eczema) that would interfere with evaluations of the effect of etanercept on psoriasis. * diagnosed with medication-induced or medication-exacerbated psoriasis. * significant concurrent medical conditions. * has any active localized infection; requiring local intervention or chronic or localized infections. * other exclusion criteria may apply.

Keywords: plaque psoriasis moderate severe etanercept enbrel topical
prevention of ponv with traditional chinese medicine

Conditions: Postoperative Nausea and Vomiting

Summary: postoperative nausea and vomiting (ponv) is particularly one of the most common complications after laparoscopic sleeve gastrectomy (lsg). it can lead to serious adverse events and delayed activity, and prolong the time of rehabilitation and discharge. numbers of studies have been focused on identifying risk factors and therapies of ponv. unfortunately, there' no consistent comments for ponv prevention in women after lsg. notably, zusanli (st36) acupoint and anisodamine have been evidenced to treat various gastrointestinal conditions. the primary outcome of this study was to evaluate the impact of anisodamine injection in st36 on ponv in women following bariatric surgery.

at the onset of this investigation, we have already identified several methodologic issues, such as the timing of the acupuncture intervention, sample size, perioperative anesthetic techniques, and appropriate control groups. all subjects were randomly assigned to the following two groups: st36 acupoint injection group (bilateral st36 acupoint injection with scopolamine); pharmacoprophylaxis group (bilateral st36 injection with normal saline). the primary outcome of this study was the total incidence of ponv during the hospital and after the discharge. participants were randomly assigned into different groups according to the computer-generated randomization sequence (http://www.randomization.com). patients, surgeons, care givers, anesthesiologists, nursing staff, and outcomes assessor, were all blinded to the group assignment.

Eligibility criteria:
inclusion criteria: 1. female patients with an american society of anesthesia (asa) physical status i-iv 2. scheduled for elective bariatric surgery 3. written informed consent was obtained exclusion criteria: 1. patients with contraindications for acupoint injection 2. difficulty in communicating with patients 3. allergic diathesis for drugs used in the study or serious illness (heart, lung, kidney, or liver, et. al) 4. coagulation dysfunction 5. pre-existing psychological or neurological disorder 6. pre-use medicine before surgery that would interferenced objective assessment (including the use of opioids, antiemetics or glucocorticoids) 7. gastroesophageal reflux disease

Keywords: postoperative nausea and vomiting bariatric surgery zusanli anisodamine obesity
effect of pilates exercise versus circuit exercise training on gestational hypertension

Conditions: Gestational Hypertension

Summary: the purpose of the study is to investigate the effect of pilates exercises versus circuit exercise training on blood pressure and lipids in gestational hypertensive women.

gestational hypertension is one of the most common disorders seen in human pregnancies. the disorder progresses into pre-eclampsia, a dangerous condition that can prove fatal to expectant mothers. if it is untreated several complications result such as eclampsia, stroke, the need for labor induction and placental abruption, preterm delivery, and low birth weight. most pregnant women use medication during pregnancy despite increasing availability of information about teratogenic risks. medication use during pregnancy still causes uncertainty and concern among pregnant women and their health care providers. medication use has a harmful effect on the fetus such as congenital anomalies, preterm birth, low birth weight, growth retardation of the fetus, and developmental delays in totality. it remains unknown what the major concerns are among pregnant women regarding medication use. health organizations recommend lifestyle changes that include increased levels of physical activity. also, some researchers have recommended aerobic training for 30 minutes per day that is supplemented with resistance exercise. pilates exercises have been showed to be safe modality for pregnant women. it showed many benefits on childbirth. it also yields a significant decrease in clinical systolic and diastolic and mean blood pressure at rest and over 24 hours, in hypertensive non-pregnant women. pilates may be recommended as a non-drug intervention for the prevention, treatment, and control hypertension. circuit exercise training is also a non-drug intervention may reduce systemic arterial hypertension to lower cardiovascular risk. due to the progressive increase in maternal estrogen with pregnancy, maternal fat deposits switch from anabolic to catabolic states to maintain appropriate development of the fetus and placenta. this switch to catabolism increases the breakdown of fat stores, which increases total cholesterol and triglyceride available for maternal and fetal utilization. further, it is essential for a normalized maternal lipid profile to ensure healthy fetal development and pregnancy outcomes. therefore, this study will be conducted to provide evidence based for the effectiveness of pilates exercise and circuit training on blood pressure and lipid profile in gestational hypertensive women for healthcare providers interested in women's health.

Eligibility criteria:
inclusion criteria: * they will be diagnosed by obstetrician after 20 weeks' gestation as having blood pressure higher than 140/90 without any organ damage. * age will range from 25-35 years old . * body mass index (bmi) will range from 30-34.9 kg/m². exclusion criteria: * cardiac problems * cognitive problems * poorly controlled hypertension * diabetes mellitus * inflammatory stage of arthritis * osteoporosis
open label comparative study of de novo renal allograft recipients receiving csa + mmf + corticosteroids versus csa + rapamune + corticosteroids

Conditions: Inflammation

Summary: to compare the safety and efficacy of cyclosporine (csa) + mycophenolate mofetil (mmf) + corticosteroids © to csa + rapamune + cs with csa elimination in the rapamune arm with the introduction of mmf in de novo renal allograft recipients.


Eligibility criteria:
inclusion criteria: * age 13 years and weight 40 kg * end-stage renal disease, with patients receiving a primary or secondary renal allograft from a living-unrelated donor, or from a living-related donor. * women who are of childbearing potential must have a negative pregnancy test before enrollment in the study and agree to use a medically acceptable method of contraception throughout the treatment period and for 3 months following discontinuation from the study. * total white blood cell count 4.0 x 109/l (4,000/mmp3p), platelet count 100 x 10p9p/l(100,000/mmp3p), fasting triglycerides ≤ 4.6 mmol/l (400 mg/dl), fasting cholesterol ≤ 7.8 mmol/l (300 mg/dl). if it is not possible to obtain fasting triglycerides and cholesterol before surgery, historical values (within 1 year) may be used. * signed and dated informed consent (parent or legal guardian must provide consent for patients \<18 years of age). an assent form will be signed by patients \< 18 years of age enrolled in the study. exclusion criteria: * evidence of active systemic or localized major infection at the time of initial sirolimus administration. * cadaveric donors * history of malignancy within 5 years before enrollment into the study (with the exception of adequately treated basal cell or squamous cell carcinoma of the skin) * use of any investigational drug other than specified in the protocol during the 4 weeks before enrolling in the study. * use of planned antibody induction therapy at the time of transplantation. * active gastrointestinal disorder that may interfere with drug absorption. * known hypersensitivity to sirolimus, mmf or cyclosporine or its derivatives. * multiple organ transplants (2 or more organ transplant e.g. kidney and pancreas). * patient with high risk of rejection (eg. patients with a pra \>50%, black patients and patients with 2nd transplant who lost their first graft within the first 6 months). * evidence of infiltrate, cavitation, or consolidation on chest x-ray obtained during pre-study screening