Kornimate/medical-research-clean huggingface dataset:
improving insulin resistance and energy metabolism through sleep extension in adolescents

Conditions: Sleep; Diabetes Mellitus, Type 2

Summary: the investigators propose to deliver a 4-week sleep extension intervention to adolescents to evaluate feasibility of the protocol and obtain preliminary data on intra-individual changes in metabolic parameters induced by sleep extension.

the specific aims of this feasibility study are to 1) examine the feasibility of recruitment and retention of adolescents with overweight/obesity, pre-diabetes, and inadequate sleep into a sleep extension intervention; 2) assess adherence of a sleep extension intervention to increase total sleep time in adolescents with overweight/obesity, pre-diabetes, and inadequate sleep; 3) determine estimates of mean and variability of potential intervention outcomes including metabolomic, body composition, and substrate oxidation. the investigators propose to deliver a 4-week sleep extension intervention to adolescents to evaluate feasibility of the protocol and obtain preliminary data on intra-individual changes in metabolic parameters induced by sleep extension. this proposal is the first step to demonstrate feasibility in delivering the intervention in a research setting, measure the effect of the intervention on changing sleep duration, and examine changes in obesity-related ir metabolites that would lead to improved ir in an adolescent population with pre-diabetes. the long-term goal is to disseminate an effective and feasible t2d prevention program that can be sustainably implemented in clinical weight management settings.

Eligibility criteria:
inclusion criteria: 1. high school students between the age of 13-19 years 2. bmi \>85th percentile for age and sex 3. prediabetes defined as a hba1c 5.7-6.4% 4. tanner stage 4-5 (based on breast development for girls and testicular size for boys) exclusion criteria: 1. any medications that affect insulin resistance or sleep (e.g., metformin, stimulants, atypical antipsychotics, current use of oral steroids) 2. regular use of melatonin or other sleep aids 3. a prior diagnosis of a sleep disorder (e.g. insomnia, delayed sleep phase syndrome, obstructive sleep apnea) or abnormal scores on sleep disorders screening measures 4. type 2 diabetes (hba1c ≥ 6.5%) 5. iq\<70 or severe mental illness that may impact sleep or ability to consent/assent (e.g., schizophrenia, psychotic episodes), verified through chart review 6. teens not enrolled in a traditional high school academic program (e.g., home school students) 7. schedules that would preclude participants from adhering to the sleep extension protocol (e.g. night shift employment) 8. travel across more than two time zones in the 2 weeks prior to the study
resynchronization of left ventricular contraction after reimplantation of anomalous left coronary artery

Conditions: Congenital Disorders

Summary: spontaneous resynchronization of dyskinetic segments of the left ventricle occurs after coronary bypass surgery in adults and has been shown in some children. it is, however, unknown what degree of dyskinesis is likely to be reversible in infants with ischemia from anomalous coronary arteries and what criteria would indicate that a resynchronization strategy of biventricular pacing might be needed. these questions need data from quantitative serial tissue doppler observations of patients from pre-operative to late post-operative follow-up.

we have previously studied, at children's healthcare of atlanta, egleston hospital, 2 patients with alcapa and one other patient is currently enrolled in a prospective study after recent surgery, also at children's healthcare of atlanta. we propose to study these 3 patients with this rare defect concurrently with their routine echocardiographic evaluations. data will then be taken off-line for analysis. standard deviations of times to peak contraction velocity will be assessed for twelve cardiac segments. these will be reevaluated at follow up intervals after surgery on previously obtained echocardiograms. those subjects in whom improvement of cardiac function, left ventricular ejection fraction (lvef) and mitral regurgitation is seen will be compared to those in whom no improvement occurs.

Eligibility criteria:
inclusion criteria: * re-implantation of an anomalous left coronary artery from the pulmonary artery exclusion criteria: * those patients who do not meet inclusion criteria

Keywords: pediatric cardiac alcapa tissue doppler imaging
endoscopic ultrasound as an early diagnostic tool for primary sclerosing cholangitis

Conditions: Primary Sclerosing Cholangitis

Summary: primary sclerosing cholangitis (psc) is a rare chronic cholestatic liver disease, typically affecting middle aged men and is frequently associated with inflammatory bowel disease. establishing diagnosis in early stages of cholestatic hepatopathy is still a clinical challenge and based on invasive diagnostic procedures: endoscopic retrograde cholangiography (erc) or percutaneous liver biopsy are needed when magnetic resonance cholangiopancreaticography remains inconclusive. as these procedures are associated with significant risks for the patient, the goal of this study is to evaluate, if endoscopic ultrasound (eus) of the biliary tract is a useful diagnostic tool in suspected psc.

different parameters of the common bile duct (wall thickness and irregularity, irregularity of the common bile duct and enlarged lymph nodes) are measured in patients with cholestatic hepatopathy of unknown causes via endoscopic ultrasound (eus). this eus of the cbd is performed from the bulbar position in the duodenum and at least 5 cm of bile duct had to be visualized to correctly analyze bile duct structure. further diagnostic work-up of these patients is performed following current guidelines, and definite diagnosis is compared with results of eus parameters measured. thus, diagnostic yield of eus in patients with suspected psc is further evaluated.

Eligibility criteria:
inclusion criteria: * cholestatic hepatopathy defined by elevation of gamma-gt and alkalic phosphatase and * elevated panca and / or medical history of inflammatory bowel disease exclusion criteria: * sign of significant intrahepatic cholestasis or any other cause of necessity of cholangiography on transabdominal ultrasound

Keywords: endoscopic ultrasound primary sclerosing cholangitis eus cholestatic hepatopathy
gastroenterology & work related injuries

Conditions: Gastroenterology & Work Related Injuries

Summary: 2.2.1. primary outcome(s) • percentage of gastroenterology fellows who have received any formal training in the ergonomics of endoscopy and how to prevent long term work related injuries. 2.2.2. secondary outcome(s) * how much formal training given in multiple choice format fellows received in the ergonomics of endoscopy and how to prevent work related injuries. * number of perceived work related injuries fellows sustained. * types of perceived work related injuries fellows sustained. * if fellow perceived work related injuries whether they felt it negatively affected their ability to perform their duties as a gastroenterology fellow.

this is a self-report survey utilizing a voluntary, non-probability sampling design. the survey instrument will be created in google survey© consisting of yes/no, multiple choice and free text response questions. this survey instrument questions have been developed empirically by the investigators. it will be distributed to all gastroenterology fellowship coordinators through an email listserv maintained by programs nationwide for the purpose of communicating with their trainees. the email will include instructions to share the survey link (appendix 2) with all first/second/third year as well as all advanced gastroenterology fellow s in their programs. the survey will be disseminated over a 2 week period. the fellowship coordinator will receive three separate emails. the first email (appendix 2) will be on opening day of the survey requesting them to forward the link to their fellows. the second email (appendix 3) will be sent on day 8 of the study period serving as a reminder to participate in the survey with link once again attached. the final email (appendix 4) will be distributed on day 14 of the study period serving as a final reminder for fellows to complete the survey if they have not already and that the survey will close at midnight. the link will have both the informed consent form and the survey. participants must press a key indicating agreement to get past the consent to the survey. the survey will take less than 2 minutes to complete electronically. this will be an anonymous survey and will be distributed via a secure online platform. the results will be compiled using google survey© software. no personal identifying information will be included.

Eligibility criteria:
inclusion criteria: * gastroenterology fellows enrolled in an accredited program in the united states * first, second and third year as well as advanced gastroenterology fellows * able and willing to provide consent exclusion criteria: * advanced gastroenterology fellows * staff gastroenterologists * unable or unwilling to provide consent
application of ultrasound radiomics in ultrasound fusion targeted prostate biopsy

Conditions: Prostate Cancer; Ultrasound; Radiomics

Summary: to predict prostate cancer and its prognosis by ultrasound radiomics in ultrasound fusion prostate targeted biopsy.

investigators plan to develop a diagnostic and prognostic evaluation model for prostate cancer according to analyze the abnormal echo of prostate ultrasound images by radiomics. the model was used to perform ultrasound radiomics fusion prostate biopsy, and the accuracy was compared with that of mri cognitive fusion biopsy.

Eligibility criteria:
inclusion criteria: 1. age ≥55 years old. 2. patients had multiparametric magnetic resonance imaging (mpmri) data within 3 months before biopsy and tpsa/fpsa within 1 month before biopsy. 3. patients had any of the following indications for prostate biopsy: * suspicious prostate nodules were found by digital rectal examination * suspicious lesions were detected by b-ultrasound or mri * psa\>10ng/ml * psa 4-10ng/ml, with abnormal f/tpsa and/or psad values exclusion criteria: 1. malignant tumors other than prostate adenocarcinoma indicated by pathology. 2. combined with other malignant tumors (such as rectal cancer, bladder cancer, testicular cancer, etc.) that may affect the imaging findings of transrectal ultrasound or mpmri. 3. other conditions that would preclude needle biopsy: cachexia, decompensation of organ function, hemorrhagic diseases, local infection, etc
the role of tranexamic acid in reducing post operative hand edema after hand and wrist surgery

Conditions: Hand Injuries and Disorders; Distal Radius Fracture; Dupuytren Contracture

Summary: hand edema following hand surgery is a common yet devastating side effect that can lead to early stiffness, prolonged rehabilitation and diminished function. these factors can reduce a patient's quality of life; mounting to an overall delay in recovery, return to work and daily activities. conventional edema therapy includes cryotherapy, external compression, active and passive exercises and various types of massage. however, there is little evidence to suggest these modalities are effective. tranexamic acid (txa) is an antifibrinolytic that has been used in surgical disciplines for decades to aid in reducing intraoperative blood loss and consequent transfusions. recently, the use of txa for curbing post-operative edema and ecchymosis has shown promising results, however, its use in hand surgery has not been studied.


Eligibility criteria:
inclusion criteria: * all patients \>18 years old undergoing distal radius fracture open reduction and internal fixation through a volar approach at st. joseph's hospital in london, ontario * all patients \>18 years old undergoing open fasciectomy for dupuytren's disease at st. joseph's hospital in london, ontario exclusion criteria: * revision surgery * distal radius fractures treated with additive or alternative approaches and fixation to the volar approach * known history of lymphedema or lymph node dissection on either upper extremity * known allergic reaction to txa * cardiovascular problems (history of myocardial infraction, angina, and atrial fibrillation) * cerebrovascular conditions (history of previous stroke) * thromboembolic disorders (history of deep vein thrombosis \[dvt\] or pulmonary embolism \[pe\]), clotting disorders) * known seizure disorder * currently on dialysis * current pregnancy or breastfeeding * current use of hormone contraception * unable to read consent and patient surveys related to the study in english

Keywords: swelling edema distal radius fracture dupuytren tranexamic acid
effects of adrenergic drugs on the fluid balance during surgery

Conditions: Ovarian Cyst

Summary: the aim this study was to examine to what degree the slow turnover of lactated ringer's solution during anesthesia and surgery can be prevented by infusing esmolol (a ß1-receptor blocker) or phenylephrine in patients undergoing laparoscopic gynecological surgery performed under intravenous anesthesia.

introduction the renal clearance of infused crystalloid fluid is very low during anaesthesia and surgery, but experiments in conscious sheep indicate that the renal fluid clearance might approach a normal rate when the adrenergic balance is modified. methods sixty females (mean age, 32 years) undergoing laparoscopic gynecological surgery were randomized to control group and received only the conventional anesthetic drugs and 20 ml/kg of lactated ringer's over 30 min. the others were also given an infusion of 50 µg/kg/min of esmolol (beta1-receptor blocker) or 0.01 µg/kg/min of phenylephrine (alpha1-adrenergic agonist) over 3 hours. the distribution and elimination of infused fluid was studied by volume kinetic analysis based on urinary excretion and blood hgb level.

Eligibility criteria:
inclusion criteria: * asa group i * scheduled for laparoscopic removal of ovarian cyst or laparoscopic hysterectomy exclusion criteria: * asa group \> i * daily medication

Keywords: pharmacokinetics, kidney; receptors, adrenergic; fluids, i.v.; sympathetic nervous system, esmolol; sympathetic nervous system, phenylephrine
dendritic cell based therapy of malignant melanoma

Conditions: Advanced Melanoma

Summary: the aim of the study is to show if vaccination with autologous dendritic cells pulsed with peptides or tumor lysate in combination with adjuvant cytokines and cyclophosphamide can induce a measurable immune response in patients with metastatic malignant melanoma, and to evaluate the clinical effect (objective response rate) of the vaccination regime.

eligible patients receive vaccination with tumor antigen pulsed autologous monocyte-derived mature dendritic cells with a fixed interval. the dendritic cells are generated from leukapheresis products and frozen after antigen loading. hla a2 positive patients are treated with padre and oncopeptide pulsed dc; p53, survivin and telomerase peptides. hla a2 negative patients are treated with klh and tumorlysate pulsed dc; autologous or allogeneic. each patient is given 6 immunizations with at least 5x106 peptide/lysate pulsed autologous dc. vaccination 1-4 is given weekly and 4-6 at 2-week intervals. those patients who exhibit stable disease, partial response or complete response after 6 injections will be given 4 more vaccinations at 2-week interval. the vaccine is applied by intradermal injection near the inguinal region. il-2 2 miu s.c. day 2-6, cyclophosphamide (sendoxan®, baxter a/s) 50 mg twice a day bi-weekly and 200 mg celecoxib (celebra®, pfizer) daily are used. scans and re-staging tests are performed at scheduled intervals throughout the study.

Eligibility criteria:
inclusion criteria: * histologically proven progressive metastatic or locally advanced melanoma * no standard treatment indicated * age: \> 18 * who-performance status 0-1 * at least tone measurable tumor lesions according to the recist criteria. * life expectancy more than 3 months * acceptable cbc and blood chemistry results * written informed consent exclusion criteria: * patients with a history of any other neoplastic disease less than 5 years ago (excepting treated carcinomas in situ of the cervix and basal/squamous cell carcinomas of the skin). * patients with metastatic disease in the central nervous system (cns). * patients with other significant illness including severe allergy, asthma, angina pectoris or congestive heart failure. * patients with acute or chronic infection including hiv, hepatitis and tuberculosis. * patients who are pregnant. * patients who have received antineoplastic therapy including chemotherapy or immunotherapy less than 4 weeks before beginning the trial. * patients who receive corticosteroids or other immunosuppressive agents. * baseline serum ldh greater than 2.5 times the upper limit of normal. * patients with active autoimmune diseases such as lupus erythematosus, rheumatoid arthritis or thyroiditis.

Keywords: dendritic cell cancer vaccine cyclophosphamide melanoma
the impact of nafamostat mesylate on the prognosis of patients with sepsis-induced coagulopathy undergoing hemofiltration

Conditions: Sepsis-induced Coagulopathy (SIC)

Summary: in sepsis, the body is prone to coagulation system disorders, which may progress to sepsis-induced coagulopathy (sic). when sic is persistent and cannot be corrected, it often sequentially develops into disseminated intravascular coagulation (dic) with multiple organ failure. nafamostat mesylate can be used as an anticoagulant during blood purification in critically ill patients and is also used to treat sic.safe and effective anticoagulation is a prerequisite for the success of blood purification therapy. for patients with active bleeding or at risk of bleeding, how to achieve extracorporeal anticoagulation without affecting the body's coagulation function is a major clinical challenge. nafamostat mesylate can reduce the risk of bleeding during blood purification, but its impact on the survival outcomes of patients with sic undergoing blood purification therapy remains unclear.the aim of this study is to evaluate the impact of nafamostat mesylate treatment on the prognosis of patients with sepsis-induced coagulopathy undergoing hemofiltration.


Eligibility criteria:
inclusion criteria: * adults (age ≥ 18 years); * patients with sic undergoing hemofiltration. exclusion criteria: * individuals under the age of 18, pregnant women, and breastfeeding mothers; * patients with a history of high sensitivity to nafamostat mesylate (those who have experienced significant bleeding complications from previous use of nafamostat mesylate); * fibrinogen \< 1.5 g/l; * patients with bleeding or high risk of bleeding: those in the acute phase of trauma or with active bleeding (e.g., flail chest, obvious contusions of the lungs, liver, spleen, retroperitoneal bleeding, pelvic fractures, etc.); those with a history of severe head trauma, intracranial surgery, stroke, cerebral aneurysm, or arteriovenous malformation within one month prior to enrollment; those with a history of congenital bleeding disorders: such as hemophilia; those with underlying fulminant hepatitis, decompensated cirrhosis, or other severe liver diseases.

Keywords: single-center, prospective, randomized controlled trial sepsis-induced coagulopathy (sic) nafamostat mesylate prognosis hemofiltration
effect of pneumoperitoneum and neuromuscular block on renal function in diabetes patients

Conditions: Diabetes Mellitus; Acute Kidney Injury; Laparoscopic Surgical Procedure; Neuromuscular Blockade

Summary: in this single center, double-blind, randomized controlled clinical trial, we will include 648 diabetes patients aged 18-70 undergoing laparoscopic pelvic tumor resection. they will be randomized to the following four groups: high-pressure pneumoperitoneum (10mmhg)+ deep neuromuscular block group, high-pressure pneumoperitoneum (15mmhg)+moderate neuromuscular block group, low-pressure pneumoperitoneum + deep neuromuscular block group and low-pressure pneumoperitoneum+moderate neuromuscular block group. deep neuromuscular block is defined as post tetanic count (ptc) 1-2, and low neuromuscular block is defined as train-of-four (tof) twitch 1-2. the outcomes will be indicators for acute kidney injury and surgical condition.

in this single center, double-blind, randomized controlled clinical trial, we will include 648 diabetes patients aged 18-70 undergoing laparoscopic pelvic tumor resection under general anesthesia. they will be randomized to the following four groups: high-pressure pneumoperitoneum (10mmhg)+ deep neuromuscular block group, high-pressure pneumoperitoneum (15mmhg)+moderate neuromuscular block group, low-pressure pneumoperitoneum + deep neuromuscular block group and low-pressure pneumoperitoneum+moderate neuromuscular block group. neuromuscular block will be induced by rocuronium bolus and maintained by a continuous infusion of rocuronium. deep neuromuscular block is defined as ptc 1-2, and low neuromuscular block is defined as train-of-four tof twitch 1-2. the primary outcome will be serum cystatin c level, and the secondary outcomes will be serum creatine level, urinary sediment, intraoperative urine output, duration of surgery, surgical space condition and occurrence bucking and body movement.

Eligibility criteria:
inclusion criteria: 1. aged 18-70; 2. american society of anesthesiologist physical status (asa) ii-ⅲ; 3. diagnosed of diabetes; 4. undergoing elective laparoscopic pelvic tumor resection under general anesthesia; 5. estimated duration of operation \>2h; exclusion criteria: 1. not willing to participate in the study or not able to sign the informed consent； 2. diagnosed of other kidney diseases except diabetic nephropathy; 3. severe renal insufficiency defined as serum creatine level \> 2 times the upper limit of normal, or urine output \< 0.5ml/kg/h, or estimated glomerular filtration rate \< 60ml/h; 4. severe liver, lung or heart dysfunction; 5. known or suspect neuromuscular disease; 6. use of drugs that may affect neuromuscular block monitoring; 7. severe diabetic neuropathy or other peripheral neuropathy； 8. known or suspect allergy to general anesthetics； 9. family history of malignant hyperthermia； 10. previous history of pelvic surgery.
minimizing pathologic aspiration in patients undergoing esophageal and lung resections for cancer

Conditions: Esophageal Cancer; Lung Cancer

Summary: the aim of this study is to reduce pathologic aspiration and pneumonia in the perioperative period by providing an oral care and oral hygiene education to patients preoperatively. patients enrolled in the study will be given a dysphagia screening questionnaire, an oral care package and oral hygiene education. patients who screen positive for dysphagia will be referred to speech pathology for evaluation. the rate of postoperative pneumonia will be determined for those who participate in the study and will be compared to retrospective patient data from our institution.

aspiration by high risk esophageal and lung cancer patients with either preexisting or post-therapy/post-operative dysphagia leads to morbidity (pneumonia) and mortality following surgery. the aim of this study is to reduce pathologic aspiration and pneumonia in the perioperative period by providing an oral care and oral hygiene education to patients preoperatively. patients enrolled in the study will be given a dysphagia screening questionnaire, an oral care package and oral hygiene education. patients who screen positive for dysphagia will be referred to speech pathology for evaluation. the rate of postoperative pneumonia will be determined for those who participate in the study and will be compared to retrospective patient data from our institution.

Eligibility criteria:
inclusion criteria: * patients undergoing elective esophageal or lung resections for cancer at our institution exclusion criteria: * none