Kornimate/medical-research-clean huggingface dataset:
regulation of stem spermatogonia in the mature testis

Conditions: Male Infertility

Summary: investigative trial to evaluate the role of a glial cell lined derived neurotrophic factor (gdnf) in regulation of spermatogonial renewal and testicular function. goal of the trial is to provide greater information on the mechanisms that effect stem spermatogonial maintenance renewal and proliferation in its relation to male infertility.

an essential requirement for sustaining male fertility is maintaining an adequate number of stem spermatogonia, the foundation of spermatogenesis. to achieve this, when the stem cells divide, some progeny must remain stem spermatogonia while other progeny differentiate. it is obvious that the correct balance between self-renewing replication and differentiation of stem spermatogonia is crucial to male fertility, and there is a indirect evidence that gdnf plays an important role in maintaining this balance in the normal mature testis. however, almost nothing is known about the in vivo regulation of this balance in the mature organ, of the specific function of gdnf in the adult testis, or if physiological changes in gdnf expression significantly affect the replication or differentiation of the stem cells. to address these critical issues, a unique mouse model that allows gdnf signaling to the stem spermatogonia to be specifically and reversibly inhibited in vivo by an atp antagonist. with this model, the first direct evidence that gdnf is required for maintaining the stem spermatogonial pool in a normal mature testis. additionally, the investigators have shown that when inhibition of gdnf signaling is reversed, the stem cells begin to rebuild the stem cell pool. importantly, our data demonstrate that some stem spermatogonia are lost when gdnf signaling is inhibited for as little as 2 days, while other stem cells survive for up to 11 days. this suggests that factors intrinsic or extrinsic to the stem cells modulate the response to gdnf. using this new mouse model the mechanisms responsible for the loss of stem spermatogonia proliferation and regeneration will be investigated along with gdnf signaling and inhibition. at the end of all of this these studies will be done on waste tissue obtained from normal men and men with infertility who otherwise have testicular surgery for therapeutic purposes.

Eligibility criteria:
inclusion criteria: * undergoing testicular biopsy at weill cornell medicine/new york presbyterian exclusion criteria: * females and any males outside of the age parameter of 18-75 years old

Keywords: male infertility spermatogonial stem cell
impact of premedication on anxiety

Conditions: Preoperative Anxiety

Summary: impact aims to evaluate the clinical routine practice of premedication in german hospitals and to estimate the influence of premedication on anxiety reduction.

generalised premedication with benzodiazepines in all surgical patients has become questionable, regarding the risk-benefit assessment and the lack of evidence for this practice. one of the main justifications for premedication with benzodiazepines is its anxiolytic effect. anxiety is associated with postoperative cognitive and behavioural changes, physiological reactions, increased need of anaesthetic drugs and altered perception of pain, mood swings, wound-healing problems and alteration of the immune system. however, several investigations revealed negative side-effects like dose-dependent sedation up to respiratory depression, prolonged extubation-time, impaired psychomotor function, paradox reactions, antegrade amnesia, increased pneumonia rates and postoperative delirium. in germany midazolam is the most frequently administered premedication. a survey revealed that about one third of the german hospitals withhold a premedication in patients older than 74 years. the evidence for this practice, as well as the indiscriminate preoperative premedication for all adult patients is low. the investigators aim to recruit as many as possible centers throughout germany, to participate in this study. a total sample size of 4000 patients will provide reasonable and valid results for the study aims. the influence of premedication on the primary endpoint change of apais-score will be analysed by a multivariable analysis of covariance considering several baseline characteristics. in case of significant interaction terms, subgroup analysis will be performed.

Eligibility criteria:
inclusion criteria: * only legally competent patients * written informed consent prior to study participation * age ≥18 years, both genders * elective surgery * expected surgery duration ≥ 30 minutes * planned general or combined regional and general anaesthesia * planned extubation (or removal of airway device) at the end of surgery exclusion criteria: * age \<18 years * non-fluency in german language * alcohol and/ or drug abuse * chronic benzodiazepine treatment * intracranial surgery * local or solely regional anaesthesia * monitored anaesthesia care/ sedation * cardiac surgery * ambulatory surgery * repeated surgery with previous participation in the trial * expected continuous mandatory ventilation after surgery * patients with severe neurological or psychiatric disorders * refusal of study participation by the patient

Keywords: midazolam premedication preoperative anxiety surgery
persistent pulmonary hypertension of the newborn (pphn) observational study

Conditions: Infant, Newborn; Infant, Low Birth Weight; Infant, Small for Gestational Age; Infant, Premature; Persistent Fetal Circulation Syndrome; Persistent Pulmonary Hypertension of Newborn

Summary: this study was an observational study to estimate the prevalence of persistent pulmonary hypertension of the newborn (pphn) among term or near-term infants with severe respiratory disease.

the optimal approach to the treatment of pphn remains controversial. in 1978, hyperventilation was advocated for the treatment of pphn. newer therapies such as alkali infusion have been introduced without the support of randomized trial. in addition, in 1993, large controlled trials of inhaled nitric oxide were in the planning stages. there is a lack of knowledge about how these diverse management styles impact patient outcome. given the large number of treatments used in neonates with pphn, we wished to document treatment of pphn and outcomes of those treatments. therefore, we performed a prospective, observational study to document prevalence of pphn, the treatments and outcomes in a large population of infants treated at the 12 centers of the national institute of child health and human development (nichd) neonatal research network. further, we sought to compare treatment with hyperventilation to treatment with alkali infusion.

Eligibility criteria:
inclusion criteria: * \>= 34 weeks gestational age * on mechanical ventilation and/or fraction of inspired oxygen \>0.50; and * had documented pulmonary artery hypertension as defined by either two-dimensional echocardiographic evidence of elevated pulmonary pressure (judged by right to left or bidirectional shunt), or a preductal to postductal oxygen gradient \>20 mm hg exclusion criteria: * \>7 days of age

Keywords: nichd neonatal research network extremely low birth weight (elbw) prematurity persistent pulmonary hypertension of newborn (pphn)
real life evaluation of rheumatoid arthritis patients in israel treated with humira

Conditions: Rheumatoid Arthritis

Summary: in israel, data is lacking regarding the long-term effectiveness of adalimumab in outpatient real life setting. moreover, the association between long-term effectiveness of adalimumab and patients' functional status as well as cultural aspects of sick leaves and visits to physician's clinics has not been demonstrated in this population. this study will collect the required data in real life settings.


Eligibility criteria:
inclusion criteria: 1. patient is eligible to adalimumab treatment according to the israeli national health basket and for whom a decision of initiating adalimumab has already been taken. patients that are naïve to adalimumab therapy, that have been prescribed adalimumab in accordance to physician's clinical decision and according to local guidelines, up to 30 days prior to screening. 2. patient has performed tuberculosis (tb) screening and treatment according to national guidelines for tb screening prior to anti tumor necrosis factor (anti-tnf) treatment. 3. patient has been diagnosed with rheumatoid arthritis (ra) and has disease duration \< 3 years. 4. patient has moderately to severely active ra defined by disease activity score (das) (moderately (3.2 ≤ das ≤ 5.1) severely (das ≥5.1)) 5. patient is able to sign written informed consent. 6. patient is treated with methotrexate (mtx) alone or in combination with other disease modifying antirheumatic drugs (dmards) 7. patient might have been treated with another anti-tnf inhibitor agent if discontinued due to secondary loss of efficacy or side effects. exclusion criteria: 1. patient with known hypersensitivity to adalimumab, or any of its components. 2. patients suffering from serious infection, latent tb or other conditions prohibiting the use of adalimumab. 3. patient had previous non-response to an anti-tnf agent. 4. patients currently treated with other biologic therapy.

Keywords: adalimumab real life ra humira rheumatoid arthritis effectiveness
neurophysiological correlates of exposition therapy in spider phobia

Conditions: Phobic Disorders

Summary: this study aims to investigate the neurophysiological correlates of spider phobia and its treatment with cbt based exposure therapy. this is the first study to investigate the neurophysiological correlates of exposure therapy in situ by means of functional near-infrared spectroscopy (fnirs). 30 spider phobic patients will be assessed and randomly allocated to 5 sessions of exposure therapy or waiting-list. further, 30 non-phobic control subjects will be assessed (primary assessment only). during exposure therapy, changes in blood oxygenation will be measured with fnirs in areas of the cognitive control network. regions of interest are the bilateral dorsolateral prefrontal cortex (dlpfc), bilateral inferior frontal gyrus (ifg) and somatosensory association cortex (sac). before the treatment, subjects will have one session of psychoeducation in which the rationale for the treatment is explained. in each therapy session subjects are exposed to 20 trials (each lasting 40s) of guided exposure by a psychotherapist. further, 20 control trials of equal length are assessed in which subjects work with an earthworm. during the therapy additional anxiety coping strategies (e.g., controlled breathing, attention refocusing, cognitive reappraisal) are trained. after the treatment or waiting-list phase, treatment conditions are switched: the waiting list will be treated and the treated subject will wait for approximately 6 weeks. before treatment (primary assessment), after treatment (secondary assessment) and after study completion (final assessment), additional combined nirs eeg measurements are done. on a peripheral physiological level heart rate and emg of the facial corrugator supercilii are measured. during these measurements subjects are asked to watch 10s lasting video clips showing spiders (experimental condition) or pets (dogs and cats). on a psychometric level, spider phobia will be assessed by questionnaires (spq, fsq, sbq) and behavioral assessments.


Eligibility criteria:
inclusion criteria: * spider phobia or no fear of spiders * age between 18 and 50 * normal vision (or corrected with glasses) * german mother tongue or comparable knowledge exclusion criteria: * pregnancy * medication with exception of contraceptive medication * acute or chronic disease that affects brain functioning (other mental diagnosis than spider phobia, cardial diseases, diabetes, kidney diseases, concussion)
sleep disturbance in chronic rhinitis

Conditions: Sleep Disturbance

Summary: the aim of this study is to evaluate the characteristic of sleep disturbance in allergic and non-allergic rhinitis in dr. cipto mangunkusumo hospital, jakarta. a cross sectional analytic descriptive study with consecutive sampling was performed. a total of 22 chronic rhinitis patients, consisted of 11 allergic and 11 non-allergic rhinitis were evaluated of their sleep disturbance's characteristics.

at first, all recruited subjects were evaluated for total nasal symptom scores (tnss) and nasal obstruction symptoms evaluation scores (nose). sleep disorder was assessed using epworth sleepiness scale (ess), pittsburg sleep quality index (psqi) questionnaires, and polysomnography (psg). both the allergic and non-allergic rhinitis groups will be compared in terms of their sleep disturbance characteristics (from comparing ess, psqi, and psg results).

Eligibility criteria:
inclusion criteria: * all male and female between 18-60 years old with chronic rhinitis symptoms and sleep disorder * did not receive intranasal steroid within the last one month * have psychiatric disorder exclusion criteria: * polyp * nasal or sinonasal tumor * septum deviation * chronic rhinosinusitis * adenoid hypertrophy * tonsil hypertrophy * macroglossia * oropharyngeal tumor

Keywords: allergic nasal congestion daytime sleepiness polysomnography
pancreatic cyst fluid glucose: new armamentarium in the diagnosis of mucinous pancreatic cystic lesion

Conditions: Pancreatic Cyst Fluid

Summary: all participants undergoing radiological imaging and found to have pancreatic cyst of size \> 2cm will be subjected to eus (endoscopic ultrasound) examination and cystic fluid will be aspirated for analysis, including cystic fluid glucose, cea, amylase. morey's biopsy will be done in the cases feasible for biopsy. the sensitivity and specificity of cystic fluid glucose level will be analysed taking cea (carcinoembryonic antigen) level with eus findings, amylase level as gold standard for diagnosis, in cases with no surgical management.

pancreatic cystic lesion prevalence noted to be increased dramatically in last few decades. earlier record showed the prevalence rate of 2.4-2.6% with magnetic resonance imaging (mri), though sometimes reaching 13.5%.recent study showed prevalence of pancreatic cysts to be 49%. most of the pancreatic cyst are benign and require conservative management and regular evaluation only. malignant cystic lesion on the other hand require immediate attention and surgical excision in most of cases. thus, diagnosis of pre-malignant \& malignant pancreatic cyst are essential, to predict the prognosis and decide further management. most widely accepted biochemical test for preoperative differentiation of mucinous from benign pancreatic cysts is cystic fluid carcinoembryonic antigen (cea). cea with cutoff value of 192 ng/ml has sensitivity, specifivcity and accuracy of 75%, 84% \& 79% respectively. this is expensive and requires a longer duration for obtaining the results. few recent studies proposed the role of cystic fluid glucose level in the diagnosis of malignant cyst.

Eligibility criteria:
inclusion criteria: * patients (between 18 to 60 years of age) * pancreatic cyst of size \>2 cm noted on radiological imaging exclusion criteria: * patient's age \ 80 yrs. * prior history of pancreatitis (within 3 months) * pregnant female * unfit for endoscopic ultrasound * not wiling for consent
correlation of aortic versus pulmonary itv in response to vascular filling

Conditions: Sepsis With Hemodynamic Instability

Summary: this is a multicenter study conducted in the emergency department of the nantes university hospital and the confluent private hospital, over a period of 5 months, based on hemodynamic ultrasound. for each patient admitted to an emergency department with a sepsis syndrome requiring vascular filling, the pulmonary itv and the aortic itv were measured at each phase of vascular filling. this is a non-interventional study, the management of patients will not differ from usual practices and vascular filling should not be delayed in any case. emergency doctors who are already experts in ultrasound, monitoring vascular filling by measuring the aortic itv, will have to measure the pulmonary itv after each filling of 250cc of ringer's lactate in 10 minutes with a limited amount of time. the evolution of itv measurements and vital parameters should be recorded for each patient. in order to ensure quality, the emergency doctors will first receive a short training (presentation of the study and review of the measurements requested). in addition, measurement records will be analyzed at random. at the end of this study, the correlation between the variation of the aortic and pulmonary itv could be compared. the objective would be to promote the monitoring of these unstable patients via the pulmonary itv. this measurement would be easier to perform than the aortic itv, which is currently only performed by emergency doctors who are experts in hemodynamic ultrasound.


Eligibility criteria:
inclusion criteria : * age\> 18 years * patient with suspected infectious syndrome * qsofa \>= 2 * tachycardia\>120 and/or pas \< 100mm hg / map \<60 mmhg exclusion criteria : * atrial fibrillation arrhythmia * vascular filling \> 500 ml before hemodynamic evaluation by echo cardiography * perfusion of catecholamine (norepinephrine, epinephrine, or dobutamine) at the time of inclusion in the study (before hemodynamic assessment by echo cardiography) * patient sedated and on positive pressure ventilation, including niv * tamponade due to a compressive pericardial or pleural effusion * patient with known pre-capillary pah \> 50 mmhg paps * presence of suspected acute valvulopathy requiring immediate cardiological expertise * absence of an acoustic window allowing the evaluation of the aortic or pulmonary itv * minor patients, adults under guardianship, protected persons

Keywords: aortic itv pulmonary itv cardiac ultrasound hemodynamic ultrasound vascular filling sepsis emergency medicine recommendations
individualized perioperative open lung ventilatory strategy

Conditions: Moderated-high Risk of Postoperative Pulmonary Complication; Abdominal Surgery Expected More Than Two Hours

Summary: the purpose of this study is to determine whether individualized ventilatory management combining the use of low tidal volumes, alveolar recruitment maneuvers, individually titrated positive end-expiratory pressure and postoperative individualized ventilatory support will decrease postoperative complications, unplanned icu readmissions, icu and hospital length of stay and mortality compared to a standardized lung protective ventilation (lpv) for all patients at risk.


Eligibility criteria:
inclusion criteria: * age not less than 18 * risk of postoperative pulmonary complication moderate-high defined by a score ≥ 26 on the risk scale ariscat (based on the analysis of seven factors, where a score between 26 and 44 points defines a moderate risk, and a score\> 44 points define a high risk, included in the information booklet investigator). * planned abdominal surgery\> 2 hours. * signed informed consent for participation in the study. exclusion criteria: * age less than 18 years. * pregnant or breast-feeding. * patients with bmi \>35. * syndrome of moderate or severe respiratory distress: pao2/fio2 \< 200 mmhg. * heart failure: nyha iv. * hemodynamic failure: ci \<2.5 l/min/m2 and / or requirements before surgery ionotropic support. * diagnosis or suspicion of intracranial hypertension (intracranial pressure\> 15 mmhg). * mechanical ventilation in the last 15 days. * presence of pneumothorax. presence of giant bullae on chest radiography or computed tomography (ct). * patient with preoperatively cpap. * participation in another experimental protocol at the time of intervention selection.

Keywords: ventilation lung lung complications postoperative complications perioperative lung protective ventilation
demonstrating the clinical and economic benefit of 5 alpha reductase inhibitor adherence in benign prostatic hyperplasia

Conditions: Prostatic Hyperplasia

Summary: this retrospective study aims to quantify the relationship between 5-alpha-reductase inhibitor (5ari) adherence / length of therapy and the likelihood of acute urinary retention (aur) or prostate surgery in patients with benign prostatic hyperplasia (bph) as well as the economic impact associated with these medical encounters. the integrated health care information solutions (ihcis) database will be utilized for this study (2000-2006).


Eligibility criteria:
inclusion criteria: * male * aged 50 years or older * a diagnostic claim of bph * prescription claim for a 5ari for at least 60 days during the observation period. * continuously eligible for 6 months prior to and at least 6 months after index date. exclusion criteria: * prostate cancer * any prostate-related surgical procedure prior to index date

Keywords: benign prostatic hyperplasia, enlarged prostate, 5-alpha-reductase inhibitor, adherence, surgery, acute urinary retention
engaging mothers & babies; reimagining antenatal care for everyone (embrace) study

Conditions: Premature Birth; Pregnancy Preterm; Prenatal Stress; Depression, Anxiety; Depression, Postpartum; Satisfaction, Patient; Health Problems in Pregnancy

Summary: this is a randomized comparative effectiveness study of two forms of enhanced prenatal care among 657 medi-cal eligible pregnant individuals in fresno, california. the goal is to see whether group prenatal care with wrap around services versus individual prenatal care supplemented by services covered by the california department of public health comprehensive perinatal services program (cpsp) results in less depression and anxiety, and more respectful, more person-centered maternity care and lower rates of preterm birth.


Eligibility criteria:
inclusion criteria: * between 8 and 24 weeks gestation at enrollment * eligible for medi-cal (at or below 213% of the federal poverty level) * speak english or spanish exclusion criteria: * unavailable to attend group prenatal care sessions * not planning to continue prenatal care with site provider * cannot legally consent to participate in the study

Keywords: premature birth group prenatal care respectful care patient satisfaction prenatal depression and anxiety low income health inequity prenatal care person-centered care