Kornimate/medical-research-clean huggingface dataset:
different volumes of local anesthetics in thoracolumbar interfascial plane block

Conditions: Postoperative Pain

Summary: ultrasound-guided thoracolumbar interfascial plane block (tlip)was first described in 2015 by hand et al which also target the dorsal rami of the thoracolumbar nerves as they pass through the paraspinal musculature(between the multifidus muscle (mf) and the longissimus muscle (lg)). the block was performed bilaterally at the level of l3 and they reported a reproducible area of anesthesia to pinprick in a mean (sd) area covering 137.4 (71.0) cm2 of the lower back (including the midline) after 20 minutes of the block. this procedure has subsequently been modified by ueshima h et al in 2016 by targeting the injection in the plane between the longissimus and iliocostalis muscles (mtlip) which helps avoiding the spread of local anesthetics to the ventral ramus and neuraxial space, thus, the modified tlip block is considered to be a more refined version of the original tlip block and safer and easier to perform. there are limited number of studies investigating the analgesic efficacy of mtlip block however, no previous study has demonstrated the ideal local anesthetic volume for this block in lumber spine surgery. moreover, this technique is considered new regional anesthetic techniques and so both of them should be involved in further studies, on the other hand the comparison between both of them at the same study wasn't discussed before, and so we will proceed at this study.

the aim of this study is to compare the post-operative analgesic efficacy of two different volumes of local anesthetics in bilateral modified thoracolumbar interfascial plane block in lumbar spine surgeries. prospective randomized double blinded study the study will be conducted in kasr alainy hospital orthopedic surgical theater. adult patients undergoing lumbar spine surgeries involving 1 up to 3 adjacent lumbar vertebrae (eg. laminectomy, discectomy ...). at kasr alainy hospital.

Eligibility criteria:
inclusion criteria: * ● both gender * type of surgery: lumbar spine surgeries involving 1 up to 3 adjacent lumbar vertebrae * physical status asa i, ii. * age 18 to 65 years. * body mass index (bmi): \> 20 kg/m2 and \< 35 kg/m2. exclusion criteria: * ● patients on preoperative opioid regimen for more than 1 month. * patients with history of previous surgical operations in the lumbar region. * patients with spinal deformities (eg. scoliosis.....). * hypersensitivity to bupivacaine. * extensive lumbar spine surgeries like large tumor excisions, scoliosis correction or more than 2 level spine fixations. * patients with communication difficulties. * lumbar spine operations that will be performed with the patient in any position other than the prone position. * severe neurological compromise (severe muscle weakness such as foot drop or sphincter disorders such as urinary incontinence).
assessment of lf-rtms in patients with visual neglect

Conditions: Neglect, Hemispatial

Summary: visual neglect is a common disorder following stroke and an indicator of poor recovery compared to stroke survivors without visual neglect. the goal of this intervention study is to assess the effectiveness of repetitive transcranial magnetic stimulation (rtms) in reducing visual neglect symptoms in patients following a stroke. the aim is to answer these questions: 1. does rtms decrease visual neglect symptoms in patients following a stroke? 2. if the treatment works, when in the rehabilitation process is it most effective to provide the treatment (6-12 weeks, 16-42 weeks or 52+ weeks after the stroke).

visual neglect is a common disorder following stroke and an indicator of poor recovery compared to stroke survivors without visual neglect. available treatment options are lacking, showing only partial and short lived effects. the goal of this intervention study is to assess the effectiveness of repetitive transcranial magnetic stimulation (rtms) in reducing visual neglect symptoms in patients following a stroke. the aim is to answer these questions: 1. does rtms decrease visual neglect symptoms in patients following a stroke? 2. if the treatment works, when in the rehabilitation process is it most effective to provide the treatment (6-12 weeks, 16-42 weeks or 52+ weeks after the stroke)? participants will undergo 1 hz low frequency rtms treatment period of 10 days at a time. three treatment periods will be provided, with one month of delay time in-between periods. repeated treatment will be provided to assess if any cumulative effects appear. participants will be assessed with behavioral tasks, phenomenological questionnaires and electroencephalography (eeg) before and after each treatment period.

Eligibility criteria:
inclusion criteria: * 1) diagnosed with visual neglect up to 10 years prior to the study. * 2) age between 18-80 years old. * 3) cbs score of \>8 * 4) informed consent provided by patient or proxy. exclusion criteria: * 1) history of epilepsy or seizure * 2) electrical device implants or metal objects in the body * 2) patients receiving end-of-life care

Keywords: visual neglect rtms eeg stroke rehabilitation perceptual disorders symptom assessment
the relationship between total sialic acid and superoxide dismutase and the diagnosis and prognosis of lipoid pneumonia

Conditions: Lipid Pneumonia; Superoxide Dismutase; Sialic Acid

Summary: the goal of this observational study is to explore the correlation between total sialic acid combined with superoxide dismutase and the diagnosis and prognosis of lipid pneumonia in the patient with lipid pneumonia, cough, bacterial and fungal pneumonia, cryptogenic organizing pneumonia, pulmonary alveolar proteinosis, lung mucinous adenocarcinoma and pulmonary edema. the main question it aims to answer is: whether superoxide dismutase (sod) and total sialic acid (tsa) could be used as diagnostic markers to distinguish lipid pneumonia from patient with cough, and bacterial and fungal pneumonia, cryptogenic organizing pneumonia, pulmonary alveolar proteinosis, lung mucinous adenocarcinoma and pulmonary edema, whether sod and tsa be associated with the prognosis of patients with lipid pneumonia? participants will answer online survey questions about their symptoms, changes in oxygen status, and changes in the most recent ct image of the lung for up to 10 years after treatment. we will count participants' baseline data including: gender, age, smoking history, comorbidities, lung function, imaging findings, hormone use or not, icu treatment, death or not, the type of cause of lipid pneumonia, how it is diagnosed, and their baseline sod and tsa.


Eligibility criteria:
inclusion criteria: 1. age≥ 18 years old; 2. the diagnosis of lipoid pneumonia must be supported by lung biopsy pathological support or positive oil red o or sudan staining in bronchoalveolar lavage fluid; 3. patients with bacterial and fungal pneumonia must be supported by etiological evidence; 4. patients with cryptogenic organizing pneumonia and pulmonary alveolar proteinosis must be supported by lung biopsy pathology; 5. patients with lung mucinous adenocarcinoma must be supported by lung tissue biopsy; 6. lung imaging of patients with pulmonary edema must show paving stone signs; exclusion criteria: 1. age\&lt; 18 years old; 2. the patient only has a history of lipid inhalation and no pathology or positive lipoid staining; 3. co-infection with the corona virus disease 2019 at the onset of illness; 4. pregnant
enhanced detection of underlying, covert atrial fibrillation using 7-day holter electrocardiogram in patients with embolic stroke of undetermined source

Conditions: Stroke

Summary: the aim of this study is to determine the diagnostic yield of continuous 7-day holter ecg for detecting covert paroxysmal atrial fibrillation in patients with recent embolic stroke or transient ischemic attack (tia) of undetermined cause after completion of a standard clinical work up including an initial 24-hour holter monitoring.

covert atrial fibrillation (af) is a relevant potential cause of a recently proposed clinical construct, "embolic stroke of undetermined source (esus)". however, routine post-stroke work up including 24-hour holter monitoring may fail to detect paroxysmal af. a recent systematic review has shown an increased af detection rate with longer monitoring durations. the aim of this study is to evaluate the effectiveness of a novel ambulatory 7-day holter ecg (ev-201, parama-tech inc.) for detecting af in patients with recent esus after completion of a standard clinical examination.

Eligibility criteria:
inclusion criteria: 1. recent esus (within 3 months of onset) defined as: a. recent ischemic stroke (including transient ischemic attack with positive neuroimaging) visualized by brain imaging that is not lacunar b. abscence of ≥ 50% stenosis or occlusion in cervical and intracranial arteries supplying ischemic area c. no atrial fibrillation after ≥ 24-hour holter monitoring d. no intra-cardiac thrombus on transthoracic echocardiography e. no other major cardioembolic sources f. no other specific cause of stroke (for example, arteritis, dissection, migraine/vasospasm, drug abuse) 2. 20 years of age or older 3. signed written informed consent exclusion criteria: 1. previously documented atrial fibrillation 2. untreated hyperthyroidism 3. pacemaker or implantable cardioverter defibrillator implanted or planned to implant 4. estimated life expectancy \< 12 months 5. examination of seven-day holter ecg not applicable within 3 months after stroke onset. 6. patients considered inappropriate to participate in the study

Keywords: embolic stroke of undetermined source atrial fibrillation
electro-acupuncture for long covid neuropsychiatric symptoms

Conditions: Long Covid19; Neuropsychiatric Symptoms; Electro-acupuncture

Summary: in this study, a 16-week randomized, sham-controlled, double-blinded clinical trial will be conducted to to investigate the efficacy and safety of electro-acupuncture compared to sham acupuncture for treatment of long covid neuropsychiatric symptoms.

this is a prospective, randomized, sham-controlled, double-blinded and multiple center trial on electro-acupuncture for treating neuropsychiatric symptoms in long covid patients. a total of 150 participants will be randomly assigned to the electro-acupuncture and the sham-control group with 1:1 ratio. both groups will receive 32 sessions of interventions during 16-week treatment duration (2 session per week), and will be followed up for 8 weeks.

Eligibility criteria:
inclusion criteria: * adults over 18 years of age to 80; * history of sars-cov-2 pcr+ at least 4 weeks prior to study entry; sars-cov-2 negative (pcr) at study entry; * at least one persistent neurological symptom (impaired concentration, headache, sensory disturbances, or depression, or "brain fog") that began around the time of the acute covid-19; * willing and able to consent, complete all assessment and study procedures. exclusion criteria: * any chronic or remote neurological disorder (i.e. stroke, head trauma, epilepsy, tumor); * intellectual disability pre-existing to the covid-19 episode;cardiovascular diseases such as arrhythmia, heart failure, myocardial infarction, and patients with cardiac pacemakers, * acute brain injury or acute encephalopathy from another aetiology than covid (e.g., sepsis, liver or renal failure, alcohol or drug withdrawal, drug toxicity); * documented pre-existing history of psychiatric illness, including substance abuse; * open-heart cardiac surgery or cardiac arrest during the last 6 months; * current hospitalization; * pregnant women.
metabolic biomarkers in thoracic cancers

Conditions: Lung Cancer

Summary: the purpose of this research study is to develop a method of using magnetic resonance imaging (mri) to evaluate lung tumors and other thoracic malignancies. an mri is a scanning device that uses magnets to make images (pictures) of the body. this study is being done to determine what series of reactions (metabolic pathways) pulmonary nodules use as they burn sugar as fuel for growth. the manner in which the tumor burns (metabolizes) sugar for fuel is being investigated by using a natural, slightly modified, sugar solution (13c-glucose) and studying a small sample of the tumor once it is removed at the time of surgery.

the recent report of the findings of the national lung screening trial indicates that screening a high-risk population using low dose ct results in a 20% reduction in lung cancer mortality. at our institution, some of positive nodules that are 1 cm or larger would be imaged using combined fluoro-deoxyglucose positron emission tomography (fdg pet)/ct. highly suspicious nodules would be biopsied if the risks were manageable. otherwise, the suspicious nodules not eligible for biopsy and so-called "indeterminate" nodules are followed using ct to be evaluated for interval growth. the overall goal of this project is to assess several very promising imaging biomarkers that can reflect either the physiological or metabolic status of these nodules in order to develop more accurate imaging algorithms for follow-up that are either less invasive or do not use ionizing radiation or both. based on our experience with other cancers and our preliminary results in lung cancer, we have identified four potential imaging studies that we believe have the potential to result in validated "imaging biomarkers" that can either individually, or in combination, characterize malignancies. since tumors tend to exhibit angiogenesis and altered vascular permeability, we and others, have found that analyses of dynamic contrast enhanced mri (dcemri) can be employed as "imaging biomarkers" for malignancy. tumors often exhibit higher cellularity than benign or normal tissue suggesting that pixel-by-pixel adc values derived from diffusion weighted mri could be useful imaging biomarkers. finally, measuring alterations in metabolic fluxes through the use of pathway specific c-13 labeled compounds, a technique pioneered here at the advanced imaging research center (airc) at ut southwestern, has shown the capability of providing metabolic fingerprints for malignant and benign tissue. this approach, while invasive, could identify and validate markers that can be detected non-invasively in future studies. we will also employ advanced metabolomics methods to identify potential signature "onco-metabolites" in these lung cancers.

Eligibility criteria:
inclusion criteria: 1. patients must have known or probable malignant lesions requiring surgical biopsy or excision. 2. subjects of all races and ethnic origins over 18 years of age. exclusion criteria: 1. not a surgical candidate. 2. poorly controlled diabetes.
long duration therapeutic ultrasound for tendon healing

Conditions: Tendinopathy; Tendinitis; Tendinosis

Summary: zetroz's ultrasonic diathermy device (sam(r) professional system) is intended for use as a portable and wearable medical device which, when applied to various areas of the body applies low intensity therapeutic ultrasound (litus) to deep tissues. this device is fda-cleared for pain reduction, treatment of muscle spasm and joint contracture, and increasing local circulation. this study will look at the use of therapeutic ultrasound to relieve pain and enhance tendon extensibility for individuals with tendinopathy over a 6 week time period.


Eligibility criteria:
inclusion criteria: * male or female * 18-65 years of age, inclusive * diagnosis of tendinitis in the elbow (lateral or medial epicondyle), achilles tendon, or patellar tendon based on examination of medical history and confirmed by physical examination including either manual movements of the injured limb, e.g., a positive mill's test for elbow tendinitis, or local tenderness upon palpation of the tendon; * body mass index (bmi) less than or equal to 30.0 * not taking nsaids or prescription pain medications for their tendinitis, and agree to document all pain medication use during the study period. exclusion criteria: * history or current diagnosis of tendon tear in treated tendon * known neuropathy * type i or type ii diabetes mellitus * had surgery in target treatment area within 6 months * refuse to agree to not increase current use or initiate new use of pain medication during the trial unless medically necessary to ensure patient safety * refuse to agree to not use any cream, gel, or topical solution during the administration of treatment other than the approved ultrasound gel provided * refuse to discontinue all other interventional treatment modalities (e.g., transcutaneous electrical nerve stimulation, other ultrasound therapy, etc.) * have had a local corticosteroid or platelet-rich plasma injection within the past 3 months * have participated in a clinical trial for an investigational drug and/or agent within 30 days prior to screening

Keywords: sustained acoustic medicine therapeutic ultrasound sam litus
the effectiveness of transcutaneous electrical nerve stimulation after thoracic surgery

Conditions: Thoracic; Surgery; Pain; Pulmonary Function; Functional Capacity

Summary: the purpose of this randomised and controlled study is to investigate the effects of transcutaneous electrical nerve stimulation combined with physiotherapy and rehabilitation program on pulmonary function and functional exercise capacity.

post-thoracotomy pain is one of the most severe types of post-surgical pain. when pain after thoracotomy is not treated effectively, it causes decrease in pulmonary compliance, inability to cough and deep breathing. increased secretion leads to atelectasis and pneumonia. after surgery, early mobilization, providing airway cleaning (humidification, aspiration, forced expiration, assisted coughing), oxygen therapy, controlled breathing exercises, the use of incentive spirometry and such selected exercises, including posture and general exercises physiotherapy and rehabilitation approaches can prevent complications. a carefully planned pre and postoperative chest physiotherapy and rehabilitation program minimizes postoperative complications; it will restore normal function in these patients. post-surgical physiotherapy applications should be combined with pain therapy for effective participation of the patient. local anesthetics, opioids and different special analgesia techniques including intercostal, paravertebral, interpleural and epidural blocks are used to relieve pain after thoracotomy. however, these techniques have serious side effects such as nausea, vomiting, respiratory depression, and sleepiness. it has been reported that the use of transcutaneous electrical nerve stimulation (tens), in addition to traditional analgesia methods, may reduce the use of analgesics, side effects, and postoperative recovery period, and is useful for pain control. after cardiac surgery, tens has been found useful in the treatment of postoperative incision pain. it has been reported that tens therapy after thoracotomy as effective as patient-controlled analgesia. therefore, this study planned to investigate the effects of transcutaneous electrical nerve stimulation combined with physiotherapy and rehabilitation program on pulmonary function and functional exercise capacity in patients undergoing thoracic surgery.

Eligibility criteria:
inclusion criteria: * patients undergoing lobectomy for lung cancer exclusion criteria: * patients undergoing pneumonectomy. * patients undergoing smaller resection than lobectomy. * presence of serious arrhythmia, pacemaker, severe cardiac failure, * patients with cooperation disorder * presence of neurological or orthopedic problems affecting the extremities. * patients with severe psychiatric disorders

Keywords: transcutaneous electrical nerve stimulation physiotherapy and rehabilitation thoracic surgery pain pulmonary function functional capacity
veterans affairs pharmacist heart failure medication titration project 1

Conditions: Heart Failure

Summary: this is a randomized quality improvement project to evaluate the impact of an audit and feedback intervention to motivate pharmacists to provide heart failure (hf) medication management to patients in the veterans health administration (vha) sierra pacific region (visn 21). the results of this project could provide guidance for how to successfully scale a pharmacist-based hf remote management program in the vha more broadly. pharmacists providing clinical care as part of patient aligned care team (pact) within vha visn 21 will be included. pharmacists will be randomized to one of 3 arms in a 1:1:2 ratio: (1) monthly audit and feedback of hf medication titration activities (af) vs. (2) educational resources and monthly notification of hf medication titration actions in addition to a list of potential patients for hf optimization (af+) vs. (3) usual care without audit and feedback (uc). pharmacists across all three arms will be given access to shared educational resources on hf pharmacist care and educational webinars. six months after the intervention, rates of pharmacist hf medication titration encounters will be compared among the 3 groups.


Eligibility criteria:
inclusion criteria: * clinical pharmacists in the veterans health administration that provide patient aligned care team (pact) care in va sierra pacific network (visn 21) exclusion criteria: * excluded per pharmacist supervisor decision

Keywords: pharmacist medication therapy
platysma incision cosmesis

Conditions: Wound Heal

Summary: the anterior cervical fusion and decompression (acdf) surgery provides direct access to symptomatic areas of the cervical spine. cosmesis, including factors like wound healing, is an important issue for patients who undergo surgery on anterior neck structures. one significant factor that impacts cosmetic healing in patients who undergo the acdf surgery is whether a vertical or transverse incision of the platysma muscle in the neck was used to access the cervical spine. the purpose of the present study is to compare cosmetic outcomes in vertical versus transverse platysmal incisions for anterior cervical spine exposures. researchers intend to analyze this effect with a prospective comparative study model. a targeted number of 100 patients who undergo anterior cervical surgery, as part of their standard of care, will be randomized to receive either a transverse or vertical platysmal incision during the exposure part of their procedure. informed consent for inclusion in the study, as approved by the institutional review board, will be obtained from all patients in addition to consent for the surgical procedure. regardless of the platysmal incision, all patients will receive a standard transverse skin incision, as is done routinely in anterior cervical exposures. after the surgery, all closures will be done in a standard manner. these patients will be followed up in the clinic at two weeks, three months, six months, and one year. they will be evaluated for wound healing and incision cosmesis using a modification of the hollander wound evaluation scale. clinical photographs of the patients' necks will be captured during these visits in a manner that does not reveal any patient identifiers in any way. the incisions and overall cosmesis will be graded using the scale mentioned above. the data will be analyzed to determine if a transverse platysmal incision offers better cosmetic results than a vertical platysmal incision, or vice versa, and will also be used to validate the modified wound evaluation scale.


Eligibility criteria:
inclusion criteria: * all patients undergoing elective anterior cervical decompression and fusion surgery for degenerative spinal pathologies by dr. tony tannoury or dr. chadi tannoury at boston medical center as part of their standard of care. exclusion criteria: * patients undergoing revision anterior cervical spine surgeries with a pre-existing scar. patients with cervical spine tumors/neoplastic pathologies. patients undergoing surgery for cervical spine trauma.

Keywords: cosmesis wound healing anterior cervical decompression and fusion acdf platysma