Kornimate/medical-research-clean huggingface dataset:
bacteriological differences between transanal and laparoscopic total mesorectal excision for rectal cancer.

Conditions: Rectum Cancer

Summary: the primary purpose of this study is to compare the differences of bacteriological in rectal cancer patients undergoing laparoscopic or transanal endoscopy radical resection. the secondary purpose is to compare the effects of two different surgical methods on postoperative complications.

transanal total mesorectal excision (tatme) is a new surgical procedure for total mesorectal excision (tme) by dissociating the mesorectum from the bottom through transanal endoscopic. the characteristics of tatme are mainly summarized as transanal reverse operation, no auxiliary abdominal incision, complete mesorectal excision and specimen removal through the anus. so tatme is a natural orifice specimen extraction procedure (noses). compared with traditional laparoscopy, tatme has obvious oncological and technical advantages. however, similar to noses, the specific surgical approach to tatme may induces bacteriological safety concerns. whether tatme is safe and feasible still needs strong evidence-based medical evidence. however, there have been prospective studies related to bacteriology in noses surgery, but there is a lack of prospective clinical studies on the issue of bacteriological diffusion during tatme surgery. bacterial contamination of the peritoneal cavity is common in laparoscopic surgery for colorectal cancer. although the standard noses procedure avoids bacteriological problems through the use of antibiotics, surgical peritoneal irrigation, and the use of sterile specimen bags, its safety remains inconclusive. therefore, compared with conventional laparoscopic colorectal cancer surgery, tatme not only takes specimens from the natural orifice, but also requires further prospective studies on whether the incision of the intestinal wall from the mucosa during the operation will violate the aseptic principle, the aseptic safety of tatme still needs further prospective studies to confirm. therefore, the investigators conducted a randomized controlled study to collect the abdominal and pelvic irrigation fluids in the transanal and laparoscopic tme surgery for bacteriological examination, to clarify the influence of the two different surgical methods on the intraoperative bacterial diffusion. the purpose of this study was to clarify the influence of two different surgical methods on the intraoperative bacterial spread, and to provide more evidence-based medical evidence for the safety of tatme surgery.

Eligibility criteria:
inclusion criteria: * primary rectal carcinoma * single lesion * no metastasis exclusion criteria: * history of malignant tumors * acute bowel obstruction, bleeding or perforation * tumor over 6cm in diameter or in severe adhesion with surrounded tissues * severe other contradictions of surgery * pregnant women will be excluded
pilot study of positive-end expiratory pressure in acute respiratory distress syndrome

Conditions: Respiratory Distress Syndrome, Adult

Summary: randomized controlled pilot trial in 70 patients with acute respiratory distress syndrome (ards) ventilated with low tidal volumes and limitation on airway pressure at 35 centimeters of water (cmh2o), to compare two different methods of selecting the level of positive end-expiratory pressure (peep) to be applied: according to fraction of inspired oxygen (fio2) needed or individualized according to the best compliance. primary objective was evolution of arterial oxygenation during the 28 days. secondary objectives were to measure its effects on hemodynamic parameters, 28-day mortality, number of ventilator-free days at day 28, intensive care unit (icu) and hospital stay, number of multiple-organ dysfunction-free days and a multivariate analysis of 28 day-mortality.

in patients with acute respiratory distress syndrome the use of positive end-expiratory pressure (peep) avoids atelectrauma, improves gas exchange and induces alveolar recruitment.although it has side effects as inducing alveolar overdistension and circulatory depression. there are several methods to determine the level of peep to be applied. we conducted a study to test the hypothesis that an individualized level of peep, set et the best compliance, when compared with a fixed level according to the fraction of inspired oxygen applied, improves oxygenation and reduces mortality rate at 28 days.

Eligibility criteria:
inclusion criteria: * patients with acute respiratory distress syndrome (ards) according to the american-european consensus conference definition, after 24 hours under mechanical ventilation. exclusion criteria: * younger than 18-year-old * pregnancy * neuromuscular diseases * intracranial hypertension. head trauma * left ventricular dysfunction * mechanical ventilation for more than 72 hours * previous barotrauma * patients with terminal stage of an illness and high risk of mortality within 90 days * patients who refused to consent to the study

Keywords: positive-pressure respiration respiration, artificial
evaluation of a model-based cbrn training program

Conditions: Chemical Accident; Radiation Exposure; Biological Substance Poisoning

Summary: the aim of the study is to evaluate the effect of the education program based on the mastery learning model for chemical, biological, radiological, and nuclear threats and hazards (mlm-cbrn education program) on student nurses' knowledge, attitude, self-efficacy, and skill development in chemical, biological, radiological and nuclear threats and hazards. the complete experimental design type was used in the study.

the aim of the study is to evaluate the effect of the education program based on the mastery learning model for chemical, biological, radiological, and nuclear threats and hazards (mlm-cbrn education program) on student nurses' knowledge, attitude, self-efficacy, and skill development in chemical, biological, radiological and nuclear threats and hazards. the complete experimental design type was used in the study. the study sample comprised 104 4th-year nursing students (52 in the experimental group, 52 in the control group). the mlm-cbrn education program was carried out with the students in the experimental group face-to-face as theoretical and practical education once a week for four weeks. as a criterion for starting a new unit, 80% of the participants needed to receive minimum 70 points from the unit follow-up tests in line with the "learning objective" determined within the scope of the mastery learning model. the data were collected before and right after the intervention and in the 1st and 3rd months after the intervention using the "personal information form," "nursing student cbrn knowledge test," "nursing student cbrn attitude scale," and "nursing student cbrn self-efficacy scale." moreover, only the knowledge scores of the students in the experimental group were collected using the unit follow-up tests, which enabled us to check whether the "learning objective" related to the unit taught was achieved. during the skill training, the "start triage and jumpstart triage skill check list," gas mask wearing-removing skill check list, and level c clothes wearing-removing skill check list were scored for each student in the experimental group after observing the students twice.

Eligibility criteria:
inclusion criteria: * being a senior nursing undergraduate student * not having received cbrn training exclusion criteria: * be a full-time worker in a healthcare institution * having taken courses on disaster and cbrn
alveolar ridge preservation using different bone substitutes

Conditions: Alveolar Ridge Enlargement

Summary: the primary objective of this study was to compare the efficacy of using allograft, autogenous tooth graft, and beta-tricalcium phosphate for alveolar ridge preservation (arp) by examining the alveolar ridge height and width at baseline and 3 months after the arp both clinically and radiographically. the secondary objective was to evaluate the quality of the newly formed bone using histomorphometric analysis.

this randomized controlled clinical trial included thirty patients. arp was performed using either allograft (allograft group n=10), tooth graft (toothgraft group n=10), and beta tri-calcium- phosphate (beta tri-calcium group n=10). changes in alveolar ridge dimensions were evaluated clinically and radiographically using cone beam computed tomography at baseline and 3 months. core bone biopsy samples were obtained 3 months post-extraction during implant placement for histomorphometric analysis.

Eligibility criteria:
inclusion criteria: 1. seeking implant-based restorations after tooth extraction. 2. exhibited no evidence of any significant medical history, measured using burket's oral medicine health history questionnaire. 3. exhibited type i and ii sockets exclusion criteria: 1. nonsmokers. 2. pregnant and breast-feeding females 3. patients with known contraindications to dental implant surgery (e.g., increased bleeding tendency, history of treatments such as radiotherapy,

Keywords: alveolar ridge preservation, allograft, toothgraft, allopast
eclampsia and posterior reversible encephalopathy syndrome (pres):

Conditions: Eclampsia

Summary: this is a double blinded, placebo-controlled trial to determine if iv dexamethasone more quickly than placebo assists resolution of posterior reversible encephalopathy syndrome (pres) encountered in eclamptic patients. all patients regardless of assignment to placebo or steroid will receive standard therapy to include magnesium sulfate, blood pressure medications and diuretics. we hypothesize that the addition of dexamethasone to standard therapy will accelerate cns recovery more quickly than standard management without dexamethasone.

30 eclamptic patients who do not require steroids for fetal lung maturation purposes will be randomized to placebo or steroid. this includes patients with eclampsia encountered antepartum prior to 23 weeks gestation, postpartum eclampsia, undelivered patients encountered after 33 weeks gestation who would not be candidates for fetal lung maturation steroids, or patients not eligible for repeat steroid administration in the 23-34 week gestational window. planned enrollment in this pilot study is up to 30 patients with at least 12 in each group.

Eligibility criteria:
inclusion criteria: 1. currently 34 weeks pregnant or within 6 weeks postpartum 2. at least 18 years of age 3. singleton or twin gestation 4. patient or family sign informed consent 5. diagnosis of eclampsia 6. able to obtain mri scanning within 24hours of hosp admit and/or seizure exclusion criteria: 1. neither pregnant nor within first 6 weeks postpartum 2. patient or family unable to sign informed consent 3. less than 18 years of age 4. triplet or higher order gestation 5. unable to obtain mri scanning within 24 hours of hospital admission ( 6. diagnosis of cerebral hemorrhage 7. patient in whom mri is contraindicated

Keywords: eclampsia
mri to assess the effect of terlipressin in patients with acute hepatorenal syndrome (hrs-aki)

Conditions: Hepato-Renal Syndrome; Portal Hypertension; Acute Kidney Injury; Liver Diseases; Liver Cirrhoses; Cirrhosis Cardiac; Cirrhosis

Summary: heptorenal syndrome (hrs) is divided into two types. a non-acute kidney injury (naki-hrs), which is predominantly related to end-stage disease and a more acute kidney injury (hrs-aki). hrs-aki is potentially reversible and develops subsequent to aggravation of a systemic circulatory vasodilatation, that triggers renal vasoconstriction and deteriorates renal perfusion and function. the albumin and terlipressin response is evaluated clinically, routinely for a week and reduces mortality with 23% compared to no treatment. only 40-50% of the patients with hrs-aki respond to the treatment with terlipressin. the treatment of hepatorenal syndrome (hrs-aki) is aimed at improving blood flow to the kidneys. flow changes associated to development of hrs have only sparsely been studied and not previously by mr technique and no previous studies have evaluated changes in flow induced by terlipressin. it has been hypothesized that development of hrs is associated to a deterioration in heart function with development of cardiomyopathy, which together with renal vasoconstriction leads to renal failure. simultaneous mr-assessments of cardiac function and flows (especially the renal flow) in hrs-aki have not previously been performed. the aim of the project is to develop new, fast and non-invasive methods to evaluate hemodynamic changes and individual pharmacological terlipressin response in patients with acute hepatorenal syndrome (type hrs-aki) we expect a higher increase in renal blood flow in terlipressin-responders compared to terlipressin-non-responders and non-responders will generally have a lower basic renal flow and a decreased cardiac output. study design and patients the study design is experimental and includes 30 cirrhotic patients with hrs-aki. patients with hrs-aki are mr scanned before and 17 minutes after their first dose of terlipressin. echo is performed before first dose of terlipressin and is repeated after one of the first doses of terlipressin. clinically efficacy is defined in accordance to international guidelines at day-7 and 90 days mortality is registered. the screening period and treatments follow international and national guidelines for acute renal failure in patients with cirrhosis.


Eligibility criteria:
inclusion criteria: * patients with cirrhosis and acute hepatorenal syndrome (hrs-aki) * patient of more than 18 and less than 78 years of age exclusion criteria: * patients who are unable to give informed consent * patients with absolute contraindication for mri * patients with absolute contraindication for terlipressin * pregnant women * patient with severe hemodynamic comorbidity

Keywords: terlipressin pharmacological respons magnetic resonance imaging hemodynamic assessments echocardiography hepatorenal syndrome - acute kidney injury
optimization of radiotherapy in treatment of painful bone metastasis

Conditions: Pain; Bone Metastasis

Summary: bone metastasis is one of the most frequent end complications of the cancer. radiation therapy is the mainstay of treatment in this disease. single fraction radiotherapy in both single and multiple bone metastasis is widely used, but optimization of the single dose fractionation is needed. two different regimens of radiotherapy dose fractionation will be investigated in both single and multiple bone metastasis and endpoints will include pain relief as well as toxicity and quality of life.

protocol schema group a treatment of single site of painful bone metastasis: arm 1: 4 gy single fraction; mandate first retreatment if moderate or severe pain persists or recurs (as measured by categorical pain scale or vas greater than 50 mm), \>4 weeks after initial rt) retreat with 8 gy single fraction; second retreatment is optional if moderate or severe pain recurs (as measured by categorical pain scale or vas greater than 50 mm), retreat with 8 gy after \> 4 weeks arm 2: 8 gy single fraction, mandate first retreatment if moderate or severe pain persists or recurs (as measured by categorical pain scale or vas greater than 50 mm), \>4 weeks after initial rt) retreat with 8 gy single fraction; second retreatment is optional if moderate or severe pain recurs (as measured by categorical pain scale or vas greater than 50 mm), retreat with 8 gy after \> 4 weeks group b treatment of multiple bone metastasis: lower hemibody radiotherapy (lhbi): arm 3: 8 gy in a single fraction; retreatments \> 4 weeks, using local rt fields to sites of residual or recurrent, moderate or severe pain with a single fraction of 8 gy) ; second reirradiation with 8 gy using local rt fields optional (at discretion of pi); arm 4: 12 gy in 4 fractions of 3 gy in 2 consecutive days interfraction interval of a minimum of 6 hrs; retreatments \> 4 weeks using local rt fields to sites of residual or recurrent, moderate or severe pain with a single fraction of 8 gy); second reirradiation with 8 gy using local rt fields optional (at discretion of pi) ;

Eligibility criteria:
inclusion criteria: * histological diagnosis of malignancy associated with radiological evidence of painful bone metastasis * if patients with two sites of pain requiring separate treatment are to be entered, the same randomized treatment option will be used for both sites, but response at each site will be scored and analyzed separately. * age \> 18 years * anticipated remaining life of at least 12 weeks (3 months) * informed consent exclusion criteria: * primary histology myeloma * sites of previous rt or previous radioisotope treatment * conditions or circumstances, which may interfere with treatment or follow-up * complicated bone metastasis (pathological fractures, metastatic spinal cord compression)

Keywords: single bone metastasis multiple bone metastasis pain relief radiotherapy
three nerves versus suprascapular nerve radiofrequency combined with hydrodissection in adhesive capsulitis

Conditions: Analgesia

Summary: comparison between effect of three nerves pulsed radiofrequency combined with hydro-dissection versus suprascapular nerve pulsed radiofrequency combined with hydrodissection on pain control in adhesive capsulitis within six months follow up.

comparison between effect of three nerves suprascapular,axillary,lateral pectoral nerves pulsed radiofrequency combined with hydro-dissection versus suprascapular nerve pulsed radiofrequency combined with hydrodissection on pain control in adhesive capsulitis within six months follow up.

Eligibility criteria:
inclusion criteria: * 1. adult patients aged 30-80 years old 2. shoulder pain existing for more than one month and reduction range of motion in at least two planes (flexion, abduction, external rotation...) exclusion criteria: 1. patient refusal 2. malignancy 3. pre-existing neurological deficits or neuropathy 4. significant concomitant shoulder pathology as instability of shoulder joint, labral tears, labral tears, rotator cuff calcific tendinopathy, infectious arthritis, and rheumatological disease of the shoulder 5. previous history of fracture or shoulder dislocation, or cerebrovascular accidents. 6. known allergic history to local anesthetic 7. known contraindications to peripheral nerve block, including local skin infections in the block procedure area, bleeding diathesis, and coagulopathy. -

Keywords: shoulder pain
combined exercise and targeted therapy for post-stroke reading deficits

Conditions: Stroke; Aphasia; Reading Disorder

Summary: the goal of the proposed project is to test the effectiveness of a novel hybrid approach to treatment of reading disorders after stroke, in which exercise training will be used in combination with a targeted reading treatment. this approach is expected to increase cerebral circulation and help to rebuild and strengthen the damaged phonological neural networks. through this combinatory approach, the study aims to enhance the reading and language improvements seen with existing treatments.

close to 2.5 million americans are currently living with post-stroke aphasia, a debilitating communication disorder affecting multiple language modalities. most stroke survivors with aphasia have acquired reading deficits, which persist chronically and severely limit life participation and autonomy. there is an urgent need for effective treatments grounded in stroke neurobiology which yield robust functional improvements. this project is a randomized controlled trial, which will recruit 70 individuals with chronic left-hemisphere stroke. participants will complete 40 sessions of targeted reading treatment combined with either 20 minutes of moderate aerobic exercise or light stretching. participants will undergo 3 magnetic resonance imaging (mri) scans, administered before the intervention, after the initial exercise session, and after the full course of treatment. they will also complete behavioral testing before and after the intervention. the outcome of this study has the potential to radically change how reading treatments are applied, increasing their effectiveness, and ultimately improving the lives of 2.5 million americans living with stroke-related aphasia. in addition, it is likely that the results will contribute to the understanding of stroke recovery mechanisms thereby fundamentally advancing the field of neurorehabilitation.

Eligibility criteria:
inclusion criteria: * fluent and literate in english prior to stroke * 1st ever stroke * more than 3 months post-stroke * post-stroke reading deficits, defined as reading aloud accuracy \<83% for single words or \<65% for readable nonwords * living within a 50-mile radius from kessler foundation. exclusion criteria: * contraindication to mri * prior neurological disease * developmental learning or reading disability (i.e., developmental dyslexia) * contraindication to exercise * concurrent speech and language therapy

Keywords: exercise stroke aphasia reading therapy phono-motor therapy aerobic exercise treatment mri
enhancing digital cbt-i to improve adherence and reduce disparities

Conditions: Insomnia

Summary: the primary objective of this research study is to increase adherence of digital cognitive behavioral treatment for insomnia (dcbt-i). additionally, this study will examine behavioral, physical, and sociocultural factors associated with treatment engagement.

insomnia is a debilitating condition that impacts one third of adults, with a majority not having access to proper treatment. digital cognitive behavioral treatment for insomnia (dcbt-i). is a method that is becoming more accessible and with strong success rate with treatment completion; however, non-completion rates are common, specifically in those with low socioeconomic status (ses). this study will examine the addition of telehealth coaching to dcbt-i to increase adherence rates. telehealth coaching will aim to provide support to mitigate the impact of lower health literacy, and will also enhance self-efficacy as a mechanism to promote treatment persistence. participants will be recruited from the henry ford health system (hfhs) outpatient network as well as the medicare/medicaid data warehouse. subjects will be screened to determine eligibility, and then will be randomized into one of two insomnia treatment groups (control dcbt-i and dcbt-i with telehealth coaching). treatment involves 6 weekly dcbt-i sessions. in the dcbt-i with coaching component, those who are at risk for treatment non-completion will be offered two telehealth sessions of brief behavioral therapy for insomnia. those in the control dcbt-i who are at risk for treatment non-completion will be provided digital sleep education. at the end of the treatment period, some participants will complete a semi-structured interview to assess for facilitators and barriers to treatment engagement.

Eligibility criteria:
inclusion criteria: * determination of insomnia (isi \>14) exclusion criteria: * age \< 18 * unwillingness/inability to participate * bipolar or seizure disorders * untreated sleep disorders other than insomnia * untreated and severe medical or psychiatric disorders

Keywords: digital cbti insomnia