Kornimate/medical-research-clean huggingface dataset:
improvement of executive functions with the co-op method in the adult subject after stroke

Conditions: Cerebrovascular Accident

Summary: the research focuses on top-down intervention approaches and more specifically on the cognitive orientation to daily occupational performance (co-op) method in the rehabilitation of executive function disorders in adult post-stroke subjects in chronic phase. the main objective of this study is therefore to improve performance in significant activities of daily living for people with chronic post-stroke dysexecutive disorders.

today, approaches to intervention with adults after stroke can be categorized into two groups: bottom-up approaches (neurodevelopmental, sensory integration, mental imagery, cognitive stimulation, perceptual-motor/kinesthetic training...) and top-down approaches (task-oriented approach, neuromotor task training, occupational performance coaching, the co-op approach). although bottom-up intervention approaches have existed for several years longer than top-down approaches, in general, top-down intervention approaches have shown better results. in the latest work with post-stroke adults with objective cognitive impairment, the data indicate the relevance of co-op in improving performance and satisfaction, attention, inhibition and flexibility or apathy. this study aims to demonstrate the effectiveness of the co-op approach in adult post-stroke patients in chronic phase, specifically on planning function, through the single case experimental design methodology by randomized intervention (3 patients) over 6 weeks of treatment and 10 weeks of evaluation.

Eligibility criteria:
inclusion criteria: * stroke responsible for a dysexecutive syndrome authenticated by the grefex battery * stroke more than 6 months old (chronic phase) * social security affiliation * signing of a free and informed consent following clear and detailed information. exclusion criteria: * disorder of comprehension objectified by the - language screening test (last) (minimum score 4/8 in expression and 6/7 in comprehension) * significant anosognosia of dysexecutive syndrome * pregnant women * neurological condition other than stroke or psychiatric disorder * patient following a rehabilitation with a liberal therapist targeting executive functions during the period of participation in the study.

Keywords: co-op executive functions stroke single-case experimental designs transfer of knowledge sens of self efficacy
neo-adjuvant transarterial chemoinfusion (tai) for patients with hepatocellular carcinoma beyond milan/ucsf criteria who underwent liver transplantation

Conditions: Hepatocellular Carcinoma; Liver Transplantation

Summary: hepatocellular carcinoma (hcc) is the second commonest cause of cancer death worldwide. liver transplantation (lt) is the best curative treatment of hcc meeting milan/ucsf criteria. milan (solitary tumour \ 4.5cm, and total tumour diameter ≤8cm) provide the benchmark requirements for lt, at which a 5-year survival of \>70% and recurrence rate ranging from 5-15% can be achieved. recently, folfox (oxaliplatin and 5-fluorouracil) based hepatic artery infusion chemotherapy (haic) exhibited high response rate for advanced hcc. neo-adjuvant tai for the hcc patients with beyond criteria serving as a down-staging method for the advanced hcc to meet milan/ucsf criteria，and qualify for lt. this study is to compare the impact on survival of neo-adjuvant tai for patients with beyond milan/ucsf criteria hcc who underwent lt.


Eligibility criteria:
inclusion criteria: 1. older than 18 years old and younger than 75 years listed for liver transplant; 2. ecog ps≤1; 3. child-pugh stage a or b 4. proven hepatocellular carcinoma according patological examination or easl/aasld diagnostic criteria; 5. not previous treated for tumor; 6. the tumor was diagnosed beyond milan criteria or university of san francisco criteria for lt 7. no distant metastasis; 8. the lab test could meet: neutrophil count≥2.0×109/l; hemoglobin≥100g/l; platelet count≥75×109/l; serum albumin≥35g/l; total bilirubin\<2-times upper limit of normal; alt\<3-times upper limit of normal; ast\<3-times upper limit of normal; serum creatine\<1.5-times upper limit of normal; pt≤upper limit of normal plus 4 seconds; inr≤2.2; 9. sign up consent. exclusion criteria: 1. cannot tolerate tai or lt; 2. distant metastasis exits; 3. known history of other malignancy; 4. be allergic to related drugs; 5. be treated before (interferon included); 6. known history of hiv infection; 7. known history of drug or alcohol abuse; 8. have gi hemorrhage or cardiac/brain vascular events within 30 days; 9. pregnancy.
etomidate versus propofol in cabg surgery

Conditions: Coronary Artery Disease

Summary: the objective of this single-blinded randomized controlled interventional clinical trial is to learn about the efficacy and long-term safety of etomidate compared to propofol as an anesthesia induction agent in patients undergoing coronary artery bypass graft (cabg) surgery. the primary aim of this study is to determine whether patients receiving etomidate or propofol exhibit similar requirements for vasopressor or ionotropic agents during both the intraoperative and postoperative periods. to achieve this goal, participants who are scheduled for cabg surgery will be randomly assigned to receive either etomidate or propofol as the principal hypnotic agent. the researchers will then compare the effects of these two anesthesia induction agents on various factors, including the need for hemodynamic support, hemodynamic stability, duration of mechanical ventilation, length of stay in the intensive care unit (icu), and overall hospital length of stay. additionally, they will assess whether there are disparities in mortality rates and readmission rates within a 6-month timeframe after the surgery. by comparing the outcomes between the two groups, the study aims to provide valuable insights into the potential differences in vasopressor or ionotropic agent requirements between etomidate and propofol. this information can help inform clinical decision-making and potentially optimize anesthesia management strategies for patients undergoing cabg surgery.


Eligibility criteria:
inclusion criteria: 1. patients scheduled for elective open coronary arteries bypass graft cabg surgery 2. patients with american society of anesthesiology (asa) physical status score i- iv 3. patients with the ability to speak and read both english and spanish exclusion criteria: 1. emergency cabg surgery, stat cases, and add-on cases. 2. refusal or lack of providing the study consent 3. patients with a known current adrenocortical insufficiency 4. a patient who is presenting with any kind of shock, (e.g. septic, hypovolemic, cardiogenic, etc.) 5. patients with chronic steroid use (defined as the use of glucocorticoids within 6 months preoperatively) 6. patients with a known allergy to etomidate or propofol. 7. patients with a known seizure disorder. 8. patients who are enrolled in other clinical research studies that can compete with this study.

Keywords: cabg surgery etomidate propofol general anesthesia induction agenats cardiothoracic anesthesia
telemedicine in pregnant women with type 1 diabetes mellitus

Conditions: Type 1 Diabetes; Pregnancy in Diabetic

Summary: hypothesize that co-managing pregnant type 1 diabetics with telemedicine will have at least equivalent outcomes to those managed with standard care. comparison of outcomes between pregnant type 1 diabetics being co-managed with telemedicine compared to those receiving conventional care will help identify unanswered clinical questions and areas for improvement in regard to standards of care for pregnant type 1 diabetics. the data generated from this analysis will help determine whether telemedicine can be an effective additional means of care for pregnant type 1 diabetic patients.

few studies have researched the use of telemedicine in the management of type 1 diabetes during pregnancy. these studies are additionally limited due to the number of patients as well as several secondary outcomes reported. therefore, this study will enroll 100 participants to reach a power of 81.8% with hba1c as a primary outcome and secondary outcomes related to diabetic management such as frequency of hypoglycemia, antenatal hospital stay (percentage requiring admission, length of stay), miscarriage, cesarean section rates, induction of labor, fetal birth weight, gestational age at birth or preterm birth (\<34 weeks, \<37 weeks), frequency of neonatal hypoglycemia, shoulder dystocia, neonatal death, major and minor anomalies, and neonatal intensive care admission.

Eligibility criteria:
inclusion criteria: * type 1 diabetics who are at or less than 16 weeks in their pregnancy * 18 years of age or more * voluntary participation exclusion criteria: * \<18 years of age * not type i diabetic

Keywords: telemedicine type 1 diabetes in pregnancy
the combination of zanubrutinib and high-dose dexamethasone as first-line treatment in adult immune thrombocytopenia

Conditions: Immune Thrombocytopenia

Summary: randomized, open-label, multicenter study to compare the efficacy and safety of zanubrutinib plus high-dose dexamethasone compared to high-dose dexamethasone monotherapy for the first-line treatment of adults with primary immune thrombocytopenia (itp).

the investigators are undertaking a parallel group, multicenter, randomized controlled trial of patients with itp in china. patients were randomized to zanubrutinib + high-dose dexamethasone and high-dose dexamethasone monotherapy group. platelet count, bleeding and other symptoms were evaluated before and after treatment. adverse events are also recorded throughout the study.

Eligibility criteria:
inclusion criteria: 1. confirmed newly-diagnosed, treatment-naive itp; 2. platelet counts \<30×10\^9/l ; 3. platelet counts \< 50×10\^9/l and significant bleeding symptoms (who bleeding scale 2 or above); 4. willing and able to sign written informed consent. exclusion criteria: 1. received chemotherapy or anticoagulants or other drugs affecting the platelet counts within 6 months before the screening visit; 2. received first-line and second-line itp-specific treatments (eg, steriods, cyclophosphamide, 6-mercaptopurine, vincristine, vinblastine, etc) ; 3. current hiv infection or hepatitis b virus or hepatitis c virus infections; 4. active infection; 5. maligancy; 6. severe medical condition (lung, hepatic or renal disorder) other than chronic itp. unstable or uncontrolled disease or condition related to or impacting cardiac function (e.g., unstable angina, congestive heart failure, uncontrolled hypertension or cardiac arrhythmia); 7. female patients who are nursing or pregnant, who may be pregnant, or who contemplate pregnancy during the study period; a history of clinically significant adverse reactions to previous corticosteroid therapy; 8. have a known diagnosis of other autoimmune diseases, established in the medical history and laboratory findings with positive results for the determination of antinuclear antibodies, anti-cardiolipin antibodies, lupus anticoagulant or direct coombs test.

Keywords: btk inhibitor high-dose dexamethasone
microbiological assessment of bile in patients undergone to endoscopic retrograde cholangiography (ercp): the "microbile registry"

Conditions: Jaundice, Obstructive; Jaundice; Malignant; Choledocholithiasis; Biliary Stricture; Biliary Disease

Summary: the study is a prospective evaluation of the microbial assessment in patients undergoing to erc with naive papilla; the population includes all the indication to biliary drainage.


Eligibility criteria:
main inclusion criteria for patient enrollment were: ability to provide an informed consent; age \>/=18 years; any benignant or malignant ercp indication. all subjects were excluded from the study: * patients who have already undergone endoscopic sphincterotomy * patients unable to express informed consent * pregnant or breastfeeding women * patients with anatomical post-surgical alterations of the upper gastrointestinal (gi) tract
population pharmacokinetic model of amikacin and vancomycin in critically ill patients

Conditions: Sepsis

Summary: the object of the scientific research is the characterization of the pharmacokinetic profile and the investigation of factors of pharmacokinetic variability of amikacin and vacnomycin in critically ill patients with a diagnosis of sepsis-like condition (sirs), hospital-acquired sepsis and/or septic shock and who are on extracorporeal therapy with cytosorb® and oxiris® adsorbents.


Eligibility criteria:
inclusion criteria: * diagnosis of sirs, sepsis and/or septic shock, * older than 18 years, who are being treated with amikacin and/or vancomycin, * length of use of adsorbent at least 12 hours. exclusion criteria: * contraindication for hemodiafiltration with adsorbents, * patients under the age of 18, * terminal cancer patients.
impact of minimally invasive restorative techniques on pregnant women oral health related quality of life

Conditions: Quality of Life; Dental Caries

Summary: aim of the study was to compare the effect of chemo-mechanical caries removal methods using papacarie-duo and alternative restorative treatment (art) on the oral health related quality of life (ohrqol) of pregnant women.

a randomized controlled clinical trial was conducted in 2019 and included 162 pregnant women visiting family health centers in alexandria, egypt with mild to moderate dental pain due to caries. participants were randomly assigned into papacarie-dup group (n=82) and art group (n=80). the outcome variable was percent change in ohrqol measured by ohip-14.

Eligibility criteria:
inclusion criteria: * having at least one carious lesion involving dentine with lesion accessible to hand instruments (international caries detection and assessment system score= 5 or 6). * suffering from at least mild dental pain as identified by a score of at least 5mm on a visual analogue scale (vas) 100-mm-long. exclusion criteria: * pregnant women with acute pulpitis, swelling or fistula. * uncooperative patients and those who refused to participate.

Keywords: minimally invasive caries removal oral health related quality of life
efficiency and safety of the prolonged use of heat and moisture exchangers in icu

Conditions: VAP - Ventilator Associated Pneumonia

Summary: filtrex is a single-centre, controlled, randomised, prospective, non-inferiority clinical trial to compare the efficiency and safety of prolonged (72-hours) versus standard (24-hours) duration of use for heat and moisture exchange (hme) filters in adult mechanically ventilated critically ill patients

rationale: ventilator-associated pneumonia (vap) is the most common hospital-acquired infection (hai) in the intensive care unit (icu), and its impact is very high in terms of morbidity, length of hospital stay and overall costs. minimising manipulation and disconnection of the ventilator circuit by reducing the frequency of hme filter exchange may lower the risk of its secondary contamination, hence the incidence of vap, while maintaining its efficacy in terms of sufficient humidification of the inhaled gas mixture and safety in terms of no or minimal change in resistance to airflow. aim: to test the effectiveness and safety of prolonged (72-hour exchange interval) use of a single hme. design: prospective, single-centre, parallel-group randomised controlled trial. subjects: icu patients (general icu) treatment in the intervention group: hme filter exchange every 72 hours control group: standard-of-care: daily hme filter exchange primary outcome: 1. presence of hme-associated adverse events (a composite endpoint of endotracheal tube occlusion or nosocomial tracheobronchitis or pneumonia). 2. the cumulative incidence of lower respiratory tract microbial colonisation analysed by the kaplan-maier method, censored in the case of icu discharge or extubation \> 24h. secondary and exploratory outcomes: differences in the relative risk of infection-related ventilator-associated complications, antibiotics (atb) exposure analysis, length of icu stay in days (time frame: three months), number of ventilator-free days (time frame: 28 days); differences in the incidence of endotracheal tube occlusion necessitating reintubation between individual groups, differences in airway resistance, humidity delivered to the patients and efficacy of hmes between groups

Eligibility criteria:
inclusion criteria: 1. age ≥18 years 2. in-patient in icu and expected to stay \> 3 days 3. mechanical ventilation or imminent need of it; predicted length of mechanical ventilation ≥ 72h 4. clinical pulmonary infection score (cpis) less than six at the baseline 5 no history and symptoms of aspiration at the baseline exclusion criteria: 1. suspected pulmonary infection on admission and in the first 48 hours of mechanical ventilation 2. pregnancy 3. acute respiratory distress syndrome 4. body temperature \< 32°c 5. airway bleeding or other contraindications for the use of hme 6. an early decision of treatment withdrawal

Keywords: pneumonia heat and moisture exchange (hme) filter vap bundle in icu endotracheal tube occlusion
early clinical examination and ultrasonography screening of acute soft tissue shoulder injuries

Conditions: Soft Tissue Shoulder Injury; Rotator Cuff Tear

Summary: the purpose of the study is to determine whether the introduction of early ultrasonography screening will change the diagnostic spectrum of soft tissue shoulder injuries in patients aged forty years or more. we also want to study whether certain physical tests will be able to predict or rule out full-thickness tears of the rotator cuff (shoulder tendons) in the acute phase. another purpose is to explore the course of soft tissue shoulder injuries over a year, as well as to compare the results to studies on the prevalence of rotator cuff full-thickness tears.


Eligibility criteria:
inclusion criteria, all of the following: * patient at section for orthopaedic emergency, oslo university hospital * living in the municipality of oslo * acute injury * sudden onset of symptoms * international classification of diseases (icd) -10 s4-diagnosis (except injuries of middle and distal third of humerus and related soft tissue) * no sign of acute injury on radiographs in two views, or successfully reduced dislocation without fracture * turns up for follow-up appointment within 21 days of injury exclusion criteria: * patients that are incapable of giving and or receiving adequate information, or that cannot undergo a normal clinical investigation, due to for example language problems, level of consciousness, drugs, mental or emotional status or other * patients that have undergone shoulder surgery during the last 6 months * injury of both shoulders * patients with neck-/shoulder problems or generalised muscle pain during the last three months before the injury * other serious disease such as cancer, rheumatic disorders, haematological, neurological, endocrinological or gastrointestinal disease that according to the doctor's best clinical judgement makes participation or follow-up difficult * does not want to participate

Keywords: soft tissue shoulder injury rotator cuff tear ultrasonography
preventing alcohol withdrawal with oral baclofen

Conditions: Alcoholism; Alcohol Withdrawal

Summary: the purpose of this study is determine if the medication baclofen can prevent the symptoms of alcohol withdrawal syndrome (aws) in hospitalized patients who may be at risk for aws. this medication is most often used for patients who have spasticity of their muscles due to a neuromuscular disease. in several european studies, and in an earlier study at essentia health (nct00597701), baclofen has been found to have a significant effect on the severity of symptoms of aws.


Eligibility criteria:
inclusion criteria: * adults (\>21) admitted to inpatients units of 1 of 3 essentia health hospitals * patient placed on aws watch protocol by admitting physicians. exclusion criteria: * unable to provide informed consent * unable to take swallow oral medications (tube-fed patients are to be excluded) * admitted for aws or with clinical institute withdrawal assessment of alcohol scale, revised (ciwa-ar) score \>8 at baseline * no alcohol intake for ≥ 48 hours or audit score \<12 at baseline * baclofen use at baseline * baclofen sensitivity * hospital discharge anticipated in within 48 hours * pregnant or breast feeding (urine pregnancy test required of women of child-bearing potential) * other active drug dependence (except tobacco)
methionine metabolism in enterally fed pediatric sepsis

Conditions: Sepsis; Critical Illness

Summary: critically ill children have abnormal utilization of nutrients such as glucose, lipids and protein. protein synthesis is increased mainly in the form of immune and signaling proteins, while muscle and structural protein synthesis is decreased. the metabolism of sulfur amino acids through the splanchnic area and specifically methionine and cysteine have not been investigated in critically ill septic children, despite that sulfur amino acids have important roles in thiol, antioxidant and epigenetic reactions. methionine metabolism in sick children will be influenced by its rate of utilization through different pathways. our study aims to investigate the metabolism of methionine and cysteine when both amino acids are given by the enteral route in critically ill septic children. the investigators are focused on the rates of transmethylation, remethylation and transsulfuration in critically ill septic children, and if the current standard nutrition maintains methionine nutritional balance and functional requirements in critically ill children fed by the enteral route.

this is a prospective, translational study on the splanchnic metabolism of methionine to determine the rates of the different pathways and synthesis rates of glutathione when critically ill children are fed by the enteral route, and the difference among various age groups. the study size will include 45 critically ill septic, pediatric patients (15 infants at 1 month-3 years of age, 15 children at 4-12 years of age and 15 adolescent at 13-19 years of age), males and females admitted to the pediatric intensive care unit (picu) at children's medical center, dallas. the minimal subject's weight will be 4 kg. the number of subjects includes an expected drop out rate of about 20%, in order to obtain 15 patients with complete data in each group. patients will receive nutritional support as per standard care. this study will yield important knowledge and may lead in the future to changes in the current practice on the management of critically ill pediatric patients in the picu.

Eligibility criteria:
inclusion criteria: 1. children age 1 month-19 years 2. diagnosis of severe sepsis diagnosed as clinical sepsis syndrome (requires two of the following criteria): * source of infection * fever or hypothermia * leukocytosis or leucopenia * poor organ perfusion (such as delayed capillary refill or decreased urine output or hypotension) * bacteremic sepsis demonstrated by positive blood culture 3. weight greater or equal to 4.0 kg 4. need for enteral nutrition by a nasogastric/nasoduodenal tube 5. presence of central and/or arterial venous access as per clinical indication exclusion criteria: 1. patients with metabolic diseases (i.e. insulin dependent diabetes mellitus, urea cycle disorders, cystinuria, etc.) 2. pregnancy 3. primary liver failure 4. primary renal failure 5. patients unable to tolerate enteral feedings 6. weight less than 4.0 kg

Keywords: methionine metabolism enteral nutrition pediatric pediatrics sepsis observational study