Kornimate/medical-research-clean huggingface dataset:
zero positive end-expiratory pressure before emergence prevents postoperative atelectasis.

Conditions: Atelectasis; Oxygenation

Summary: a study on healthy patients undergoing anesthesia for non-abdominal surgery - evaluation of positive end-expiratory pressure versus zero positive end-expiratory pressure on the amount of atelectasis in the early postoperative period.

positive end-expiratory pressure (peep) is often used during mechanical ventilation to preserve end-expiratory lung volume. after emergence and extubation, this volume will diminish instantly. some patients will have difficulties to restore functional residual capacity (frc) during the early phase of recovery. if routine high fio2 has been delivered together with maintained peep prior to extubation, several important prerequisites are established for the development of postoperative atelectasis. the investigators hypothesize that establishing zero positive end-expiratory pressure (zeep) immediately prior to emergence preoxygenation, will prevent gas with high oxygen concentration from entering dorso-basal areas of the lungs, and thereby prevent postoperative atelectasis formation. this randomized controlled study will study patients undergoing non-abdominal day case surgeries under general anesthesia. the patients in the two study groups will receive mechanical ventilation with identical settings, comprising low tv, moderate peep, and no rm. at the end of surgery, the lungs will be examined by ct, and any atelectasis areas will be calculated. randomization will occur after the first ct. the patients will be allocated to zero peep (zeep) or maintained peep during emergence preoxygenation and extubation. importantly, the intervention group will have zeep established while still having low eto2 levels, prior to any preoxygenation. the study subjects will be examined with ct no.2 approximately thirty min after extubation. primary endpoint measure will be atelectasis area as a percentage of total lung area. blood gases will be collected for comparison of oxygenation as a secondary outcome measure.

Eligibility criteria:
inclusion criteria: * american society of anesthesiology (asa) class i-ii * non-abdominal day case surgery under general anesthesia exclusion criteria: * body mass index (bmi) ≥30 kg/m2 * arterial oxygen saturation (spo2) breathing air \<95 % * chronic obstructive pulmonary disease (copd) or symptomatic asthma * symptomatic congestive heart failure * ischemic heart disease * hemoglobin \<100 g/l * active smokers * active smokers and ex-smokers with a history of more than 6 pack years. * need for interscalene or supraclavicular plexus block for postoperative pain relief (risk of phrenic nerve paralysis).

Keywords: atelectasis oxygenation positive end-expiratory pressure mechanical ventilation general anesthesia computed tomography
the effect of propolis administration on cholesterol level in diabetic type 2 patients

Conditions: Diabetes Mellitus Type 2

Summary: the goal of this clinical trial is to learn if propolis administration works to change the level of low density lipoprotein (ldl) and high density lipoprotein cholesterol (hdl) in diabetic type 2 patients. the main questions it aims to answer are: - is giving 1 drops/ 10kg/ times, twice daily for 8 weeks will change the level of ldl and hdl level in diabetic type 2 patients compared to placebo? researchers will compare propolis to a placebo (a look-alike substance that contains no drug) to see if propolis works to change ldl and hdl cholesterol level. participants will: * take propolis or a placebo, 2 times daily with given dose (1 drops/10 kg/times) every day for 2 months * visit the sub-district health centre once every 2 weeks for checkups * get their blood checked before and after intervention

subject allocation into groups will be made by third party to ensure masking/ blinding protocol. data that will be taken from participants : * private information * medication history (for type 2 diabetes mellitus) * food intake (calories, fats, carbohydrate, protein, and flavonoid intake) * physical activity status

Eligibility criteria:
inclusion criteria: * controlled diabetes mellitus type 2 with hba1c \<7.5% * bmi 23-35 kg/m2 * on anti-cholesterol therapy exclusion criteria: * using injection therapy (insulin or glp-1 ra) * history of bees product allergy * active smoker * consuming alcohol * altered liver (alt\>35 iu/l) and kidney (egfr\<90 ml/min) function * pregnant and breastfeeding women * history of cardiovascular disease (heart attack, stroke)

Keywords: propolis diabetes mellitus type 2 low density lipoprotein high density lipoprotein
caregiver burden and correlation with clinical outcome in spinal cord stimulation for chronic neuropathic pain

Conditions: Pain, Chronic; Pain, Neuropathic; Failed Back Surgery Syndrome

Summary: prospective multicentric observational trial on caregiver burden, caregiver satisfaction and clinical outcome in spinal cord stimulation for chronic neuropathic pain.

spinal cord stimulation is an effective therapy for chronic neuropathic pain. after careful selection, the satisfaction for the patient is often considerable. the investigators want to investigate the caregiver burden for relatives of patients who are treated with spinal cord stimulation. this will be evaluated by appropriate scores at baseline, during neurostimulator trial and 3,6 and 12 months after implantation. at the same time the patient satisfaction and pain reduction will also be evaluated independently. in this prospective cohort different parameters will be assessed at baseline, trial, 3, 6 and 12 months follow-up for the patient and their caregiver. for the patient this will include numeric rating scale (nrs) for leg and back pain, oswestry disability index (odi), euroquality of life-5 dimensions score (eq5d), opiate use and relation quality index (rqi). for the caregiver the zarit burden index (zbi), relation quality index (rqi) and modified caregiver strain index (mcsi). with regard to the research questions, subgroup analysis will be performed regarding to age, sex, education, neurostimulation pattern, surgical vs percutaneous lead placement, working status of both patient and caregiver and caregiver relation characteristics.

Eligibility criteria:
inclusion criteria: * patients age \> 18 years * patients with an identified spousal or offspring caregiver * patients receiving neurostimulator for the first time * patient complies to reimbursement criteria for spinal cord stimulation in belgium exclusion criteria: * non-spinal cord type of neuromodulation (drg, occipital, peripheral nerve, ) * revision cases, previous neuromodulation * patients unable to consent for this study * patients without identified spousal or offspring caregiver
predictive utility of dasimar as a prognostic biomarker in acute-on-chronic liver failure (aclf)

Conditions: Liver Cirrhosis

Summary: patients with acute on chronic liver failure have a risk of developing multiorgan failure and a high mortality. the current scoring systems defining the outcome of patients with acute decompensation of cirrhosis fail to identify patients that progress to acute-on-chronic liver failure (aclf). the aim of the study is to evaluate if one can identify these patients early on with the proposed biomarkers: dimethylarginines and ischemia modified albumin.

patients with acute-on-chronic liver failure (aclf) are at risk of multiorgan failure and high mortality. recent data suggest that patients with decompensated liver cirrhosis have higher adma (asymmetrical dimethylarginine) levels compared to compensated cirrhosis and plasma adma levels correlate with severity of liver dysfunction and inflammation. there is also an increase in symmetric dimethylarginine (sdma), a stereo-isomer of adma, which is largely excreted by the kidney. plasma sdma levels have been shown to be associated with patients progressing to renal failure. in a pilot study by our group involving 52 patients with acute decompensation of chronic liver disease, we showed an increase in the summed product of adma and sdma, which we termed dimethylarginine score ('das'): this was shown to have a good predictive utility for outcome in this small group of patients (auroc=0.89). furthermore, we and others have shown that albumin of patients with advanced liver disease has widespread abnormalities. the amount of albumin that is found to have reduced metal binding capacity as a consequence of oxidative damage is termed ischemia modified albumin (ima). our data shows that patients with aclf who die have a significantly increased ima/serum albumin ratio (imar). the summation of these two pathologically relevant biomarkers (das+imar) we termed dasimar and found this score to have a better predictive utility than das alone (auroc:0.91). primary objective : to identify the patients early on that progress to aclf which would facilitate a goal directed therapeutic approach. secondary objective : generation of this dataset will further define and enable prognostication of aclf. if this study reveals a role for these biomarkers in patients with aclf, commercial development of simple kits may be possible.

Eligibility criteria:
inclusion criteria: * all patients with an acute clinical decompensation of presumed cirrhosis (elevated bilirubin \>85 µmol/l, or/and increasing ascites or/and hepatic encephalopathy \< grade 2) related to a clear precipitating event (e.g. infection, bleeding, alcoholic hepatitis, exposure to hepatotoxin) exclusion criteria: * admission for reasons other than decompensation of cirrhosis (other co-morbid diseases, especially established cardiovascular or renal disease (u/s). * malignancy (extra-hepatic or a hepatocellular carcinoma). * patients who have undergone major surgery or have unsolved surgical problems. * pregnancy
community-based program to treat childhood obesity

Conditions: Childhood Obesity

Summary: this study will evaluate the effectiveness of a comprehensive community based program on reducing excess weight in children and teens. this study will recruit 150 participants between the ages of 6-12 and 13-17.

this study will evaluate the effectiveness of a comprehensive community based program on reducing excess weight. overweight and obese study participants will be grouped with peers of similar ages and their parent/guardians. the participants will be divided into 2 groups, child (6-12 yrs. old) and teens (13-17 yrs. old) and will be accompanied by their parent/guardian. 150 participants will be recruited for this study. this 6-month program (12 in-person group workshop sessions and 12 at-home sessions) takes the best components of current evidence for individual treatment and places them in a comprehensive community based program. these include: * parental involvement * reduction in consumption of sugar sweetened beverages * reduction of screen time * self-monitoring * physical activity * stimulus control

Eligibility criteria:
inclusion criteria * children and teens between the ages of 6-17 * bmi percentile ≥85 * participation of a parent/guardian exclusion criteria: * enrollment in another weight loss program or study * diagnosis of type 1 or type 2 diabetes * pre-existing medical conditions (e.g., prader willi) that affect weight and appetite * medications (e.g., steroids) that affect weight or appetite * serious or unstable medical or psychological conditions that, in the opinion of the principal investigator, would compromise the participant's safety or successful participation in the study

Keywords: childhood obesity group treatment community-based programs
the optimal leg angulation of femoral central catheterization in pediatrics

Conditions: Pediatric Disorder; Femoral Artery Injury; Emergencies

Summary: evaluation for the range of smallest leg angulation with femoral artery and vein overlap with femoral central catheterization in pediatrics.

in pediatrics, femoral vein catheterization often overlaps with the femoral artery. in this case, the risk of artery puncture is high, vein collapse when artery puncture 2nd, 3rd times exceeds the success rate of catheterization becomes low. in previous study, comparing 0, 30, and 60 degrees with frog leg position, there was a study that the overlap was the smallest at 60 degrees. a previous study was a simple frog leg position and a study in fragmented predetermined angles. on a continuous measurement, we planned the study under the assumption that there is a more definite range of optimal angulation. ultrasound probe in the state of inguinal crease, we find a part without bifurcation of femoral artery and femoral vein in frog leg position(external rotation + flexion increase). increase the leg angle and check the vein and arterie relations.

Eligibility criteria:
inclusion criteria: 1. pediatric patients younger than 3 years 2. asa class 1-3 3. patients scheduled for elective surgery. 4. if the patient's guardian can understand and write the contents of the agreement. exclusion criteria: 1. a patient with previous history of dislocation of the hip. 2. hip joints with limited hip movement. 3. a patient with vascular malformation of the femoral vein 4. emergency surgery 5. hemodynamic unstable patient 6. if the patient's guardian cannot understand and write the contents of the agreement.

Keywords: central catheterization femoral vein central catheterization leg angulation
identification, electro-mechanical characterisation and ablation of driver regions in persistent atrial fibrillation

Conditions: Atrial Tachycardia

Summary: atrial fibrillation (af) is the most common sustained heart rhythm abnormality. its incidence is increasing partly due to the aging population and it has been referred to as a growing epidemic. af results in irregular contractions of the heart causing unpleasant symptoms of palpitations and increasing the risk of stroke, heart failure and death. percutaneous catheter ablation is a safe treatment option in symptomatic patients with af. the success rate of these procedures have improved with time due to our better understanding of af, development of new techniques and technology, and greater physician experience. however, the success rate of these procedures still only remains around 70%. this is secondary to our limited ability to find the areas that drive af. star mapping is a novel mapping system that has been developed with a view of better identifying the sites that drive af through taking into account the mechanisms of af we have so far demonstrated. to validate this mapping system we aim to use it in patients with atrial tachycardia (at), which is a heart rhythm abnormality of which the mechanism can be readily identified with the existing mapping systems used in clinical practice. we will demonstrate that the star mapping algorithm can effectively map at.

at is a heart rhythm that currently can be effectively mapped and ablated using existing mapping systems. the mechanism of this heart rhythm is well understood. patients that are scheduled for a catheter ablation for at by their electrophysiologist will be enrolled into the study. the patient will have the procedure under local anaesthetics/sedation or general anaesthetic depending on their clinical need. during the procedure tubes will be passed into the left upper chamber of the heart through the groin. through these tubes catheters will be used to create a geometry of the heart chamber. following this, in half of the patients a basket catheter with 64 electrodes will be positioned in the upper chamber whilst conventional catheters will be used in the other half of the patients. the aim of this is to demonstrate that the star mapping can be used with multiple mapping catheters. signals i.e. electrograms will then be collected and used with the star mapping algorithm. the at will then be effectively mapped and ablated with a conventional mapping system. the star mapping will then be used for post processing after the case to map the at and will be compared to the maps generated by the conventional system. this will enable validation of the star mapping system.

Eligibility criteria:
inclusion criteria: 1. patients able to provide informed consent 2. patients with at (whether de novo or occurring post af ablation) exclusion criteria: 1. unwillingness to sign consent 2. age \<18 years old 3. contraindications for catheter ablation procedure

Keywords: atrial tachycardia, electrogram, ablation, drivers
early immunosuppressants in crohn's disease

Conditions: Crohn's Disease

Summary: pluricentric randomized study comparing two therapeutic strategies at beginning of crohn's disease: early immunosuppressants (prescription within the six first months following diagnosis) vs. conventional strategy (immunosuppressants given only in case of steroid failure, in a selected group of patients being at high risk of disabling course. the hypothesis is that immunosuppressants given early may improve the disease course during the 3 following years in this subset of patients.


Eligibility criteria:
inclusion criteria: * \> 18 yr old * diagnosis of crohn's disease * intestinal lesions demonstrated during the last 6 months * disease duration \< 6 months * patients at high risk of disabling disease (having 2 criteria out of the 3 following: age \< 40, perinanal disease, steroid for the first flare) exclusion criteria: * prior prescription of immunosuppressants * severe course requiring early immunosuppressants (steroid resistance, xtensive disease, disabling perianal disease) * intestinal resection * active infectious disease including hiv * hepatic failure * renal failure * pregnancy * high probability of poor compliance

Keywords: crohn immunosuppressants natural history steroids
a comparison of insorb staples with metal staples in total hip replacement

Conditions: Erythema; Drainage; Bruising; Pain

Summary: the purpose of this study is to compare the use of insorb absorbable staples with metal staples on surgical incision healing after total hip replacement. the study evaluates wound healing, complications, and patient satisfaction regarding wound comfort and appearance after surgery.

subcuticular closure of wounds can provide superior results to percutaneous suture closure due to the elimination of suture or staple tracts. these tracts can lead to infection and migration of epithelial cells adding to scarring, and cross-hatching scars which remain after healing. absorbable staples can provide a rapid, secure, subcuticular closure of skin as an alternative to the traditional, manual staple or suture closure. this study will compare insorb absorbable staples to externally applied standard metal staples with respect to effectiveness of incision closure, acute healing, subject comfort level, security and appearance after total hip replacement.

Eligibility criteria:
inclusion criteria: * patient is 18 years or older * patient or legal representative is able to understand and provide signed consent for the procedure * patient is willing and able to return for required follow-up visits * patient needs a total hip arthroplasty surgical procedure exclusion criteria: * patient has an active infection * patient is enrolled in another similar study * patient has a known history of hepatitis * patient has a known history of hiv * patient has a known history of aids * patient has a known history of iv drug abuse

Keywords: insorb staples metal staples
paclitaxel in treating patients with recurrent or persistent ovarian or primary peritoneal cancer

Conditions: Ovarian Cancer; Primary Peritoneal Cavity Cancer

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. purpose: phase i trial to study the effectiveness of paclitaxel in treating patients who have recurrent or persistent ovarian or primary peritoneal cancer.

objectives: i. determine the safety and tolerability of intraperitoneal administration of paclitaxel (paclimer microspheres) in patients with recurrent or persistent ovarian or primary peritoneal carcinoma. ii. determine and confirm the maximum tolerated dose of this regimen in this patient population. iii. determine plasma paclitaxel concentrations at selected times after intraperitoneal administration of paclimer microspheres in these patients. outline: this is a dose escalation study. patients receive intraperitoneal paclitaxel (paclimer microspheres) every 8 weeks for 2 courses. cohorts of 1-3 patients receive escalating doses of intraperitoneal paclitaxel (paclimer microspheres) until the maximum tolerated dose (mtd) is determined. the mtd is defined as the dose preceding that at which 2 of 3 patients experience dose limiting toxicities. once the probable mtd is determined, an additional cohort of 8 patients is accrued to confirm the mtd. the mtd is confirmed as the dose level at which at least 6 of 8 patients demonstrate acceptable safety and tolerability. projected accrual: a maximum of 24 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: recurrent or persistent ovarian and/or primary peritoneal carcinoma adequate potential intraperitoneal fluid distribution with no gross fluid loculations and adhesions that would significantly affect intraperitoneal drug distribution patient characteristics: age: 21 and over performance status: gog 0-2 life expectancy: at least 6 months hematopoietic: absolute neutrophil count at least 1,500/mm3 wbc at least 3,000/mm3 platelet count at least 100,000/mm3 granulocyte count at least 1,500/mm3 hepatic: bilirubin no greater than 1.5 times upper limit of normal renal: creatinine less than 2.0 mg/dl other: no other sufficiently severe medical problems unrelated to malignancy that would preclude study compliance or cause exposure to undue risks no prior unmanageable reaction to paclitaxel prior concurrent therapy: biologic therapy: not specified chemotherapy: at least 4 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosourea and mitomycin) and recovered endocrine therapy: not specified radiotherapy: at least 4 weeks since prior radiotherapy to major bone marrow containing areas surgery: not specified other: at least 1 month since other prior investigational agents

Keywords: recurrent ovarian epithelial cancer primary peritoneal cavity cancer
glycemia in diabetic elders trial

Conditions: Type 2 Diabetes Mellitus

Summary: this study is a pilot randomized controlled trial of 30 elderly type 2 diabetes patients conducted at the model clinical research (model), research division of bay west endocrinology associates in baltimore, maryland. the investigators hypothesized that compared to a regimen base solely on traditional drugs, a regimen including newer drugs will achieve glycemic target faster and induce less hypoglycemia, weight gain, and other side effects, over the short run.


Eligibility criteria:
inclusion criteria: * type 2 diabetics diagnosed for at least 6 months * patients ages ≥ 65 years and older * active patients in the bay west endocrinology practice * inadequately controlled on oral agents and/or basal insulin with hba1c between 8.0% and 12% * eligible for randomization to either treatment group * patients willing to follow either treatment arm including regimen using one or more injectables * patients to have an english reading level of grade 6 or above * patients residing at home exclusion criteria: * unwilling to use a regimen that may contain using one or more injections * using short acting insulin prior to the study * using glp-1 in past 10 weeks * history of hypoglycemia unawareness or episodes needing emergency intervention * end-stage renal disease * dementia * blindness * terminal illness