Kornimate/medical-research-clean huggingface dataset:
efficacy and safety of citrate anticoagulation in crrt for patients with liver failure/dysfunction, the caution trial! a retrospective study on etiology of liver failure and their complications

Conditions: Liver Failure; AKI - Acute Kidney Injury

Summary: study design a retrospective cohort study will be conducted to compare the efficacy and safety of citrate anticoagulation in crrt among patients with liver failure/dysfunction and severe shock. objectives 1. primary objective: to determine if the etiology of liver failure impacts the incidence of citrate-related complications in patients undergoing crrt. 2. secondary objectives: to compare the efficacy of citrate anticoagulation in terms of renal recovery, filter lifespan, and patient survival between those with liver failure/dysfunction and severe shock.

continuous renal replacement therapy (crrt) is a crucial intervention for managing acute kidney injury (aki) in critically ill patients. citrate anticoagulation has become a preferred method in crrt due to its effect in longer filter longevity and less bleeding compared to unfractionated heparin1. however, its use in specific patient populations, such as those with liver failure or severe shock, necessitates careful evaluation. citrate acts as an anticoagulant by chelating calcium, an essential cofactor in the coagulation cascade, thus preventing clot formation within the extracorporeal circuit2. the citrate-calcium complex is then metabolized mainly in the liver, where citrate is converted into bicarbonate, and calcium is released back into the bloodstream. this mechanism provides dual benefits: effective anticoagulation and metabolic alkalization. patients with liver failure present unique challenges for citrate anticoagulation. impaired liver function can lead to the accumulation of citrate, resulting in high anion gap metabolic acidosis and hypocalcemia3. these risks underscore the need for vigilant monitoring and potential adjustment of citrate dosing in this population. the aim of the present study is to explore whether the etiology of liver failure, which can range from alcoholic liver disease to drug-induced liver injury or shock liver, influences the incidence and severity of citrate-related complications.

Eligibility criteria:
inclusion criteria: * critically ill patients diagnosed with aki requiring crrt. caution protocol v1.0 24-07-2024 * documented liver failure or significant liver dysfunction (e.g., elevated liver enzymes, bilirubin levels, or clinical diagnosis of liver failure) and clincal diagnosis of shock (ne of 0.25 μg/kg/min and or association of second vasopressor). * age ≥ 18 years. exclusion criteria: * na

Keywords: crrt liver failure aki
improving treatment personalization of pulmonary hypertension associated with diastolic heart failure

Conditions: Pulmonary Hypertension; Diastolic Heart Failure; Heart Failure With Preserved Ejection Fraction

Summary: heart failure with preserved ejection fraction (hfpef), is one of the leading causes of pulmonary hypertension (ph). despite the severity of this disease, no established treatments exist for this class of ph. nebivolol is a drug used in high blood pressure and heart failure, but not used in patients with ph. due to some additional properties it possesses, the investigators believe nebivolol will improve disease severity in patients with ph associated with hfpef. the hypothesis of this research study is that nebivolol improves ph severity in patients with hfpef, as measured by hemodynamic and clinical parameters.

this research study will be a prospective, open-label 18-week clinical study of nebivolol in patients with ph associated with hfpef. patients will be identified in clinic based on echocardiogram (tte) and right heart catheterization (rhc) results (both part of standard clinical care) indicating ph and hfpef.

Eligibility criteria:
inclusion criteria: * adults (≥ 18 years of age) with world health organization group 2 pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mmhg and pulmonary capillary wedge pressure ≥ 15 mmhg) * new york heart association class ii-iv symptoms * left ventricular ejection fraction (lvef) ≥ 45% exclusion criteria: * other causes of heart failure other than diastolic dysfunction, such as restrictive cardiomyopathy or infiltrative cardiomyopathy * women who are pregnant or nursing * liver cirrhosis, * primary valvular disease * acute coronary syndrome * causes of ph other than that of heart failure, such as: chronic thromboembolic ph, sickle-cell disease, or sarcoidosis * severe bradycardia or greater than 1st degree heart block * decompensated heart failure * current use of a third generation beta-blocker (nebivolol, carvedilol, or labetalol) or high dose of any beta-blockers (greater than 100 mg daily of metoprolol, or equivalent)
suprapostural attention focus and postural difficulty on h-reflex and brain activity: aging and parkinson's disease

Conditions: Parkinson

Summary: inherent with intricate allocation of brain resource and attention shift, postural-suprapostural task is defined as postural control takes place while the other concurrent task is being performed. recent studies have indicated that attentional focusing alters attention allocation in the brain as well as motor performance of a postural-suprapostural task. also, most studies have demonstrated benefits of inducing an external focus relative to internal focus for motor performance. however, postural difficulty might be a critical factor for choosing an appropriate focusing strategy, and the strategy used in a particular difficulty level do not always generalize to other difficulty levels. besides, despite a lot of studies have been done, current findings are confined to behavioral observations in young healthy adults for lacking direct neural evidence. with the uses of h-reflex, event-related potential and behavioral measures, the purpose of the 3-year research project is to investigate the differences in performance quality and intrinsic neural mechanisms of a postural-suprapostural task for older adults and patients with parkinson's disease, by adopting external and internal strategies for suprapostural task under different posture difficulties. in the first year, the investigators will characterize suprapostural focusing effect on reciprocity of a postural-suprapostural task, with a special focus on modulation of motoneuron excitability in sitting and standing posture for healthy young and older adults using h-reflex technique. in the second year, the adaptive selection of suprapostural focusing strategy will be investigated for patients with parkinson's disease by varying the standing surface (stable/unstable surface). in the third year, the investigators will investigate suprapostural focusing effect on brain resource allocation for patients with parkinson's disease, in light of event-related potential and movement-related potential. the present project is expected to have significant contributions not only to gain a better insight to neural correlates of concurrent postural and motor suprapostural tasks with internal/external focusing strategy under different posture difficulty, but to optimize treatment strategy for older adults and patients with parkinson's disease with balance or multi-tasking disturbances.


Eligibility criteria:
inclusion criteria * independent standing balance on air pillow at least 20 sec * no neurologic or orthopedic disorder exclusion criteria * had relative experience before * pregnant women

Keywords: aging external focus internal focus attention posture balance parkinson's disease
mistletoe extract in early or advanced breast cancer, a feasibility study

Conditions: Metastatic Breast Cancer

Summary: the purpose of this feasibility study is to identify appropriate surrogate parameters for a randomized study to examine the efficacy of a complementary therapy with an extract of viscum album (iscador p) in patients with breast cancer.

the study consists of three parts. part 1 is a prospective non-randomized feasibility study in patients with breast cancer after primary surgery during chemotherapy or endocrine therapy comparing blood count, lymphocytes, quality of life and local and general side effects between the groups part 2 is a prospective randomized feasibility study with a waiting list for three months comparing changes in quality of life, depression, diurnal cortisol profile and expression of zeta-chains in t- and nk-cells after three months of treatment or waiting in patients of two different strata (early breast cancer uicc i/ii and metastatic breast cancer) part 3 consists of two follow-up periods of 12 months respective. patients may choose to continue, quit or restart mistletoe treatment upon their own decision, endpoints from part 2 are evaluated every 6 months.

Eligibility criteria:
inclusion criteria: * breast cancer * desire for additional therapy with mistletoe extracts exclusion criteria: * contraindication for a therapy with mistletoe extracts(allergy, tuberculosis, hyperthyreosis, acute infectious disease, intracranial pressure in case of tumors or metastasis) * current medication with glucocorticoids or other immunosuppressive therapies * other concomitant complementary therapies * prior therapy with mistletoe extracts \> 2 years or during the last 6 months * karnofsky-index \<60

Keywords: breast cancer mistletoe complementary therapy quality of life immune function breast cancer (uicc stage i/ii)
expediting access to services for equity

Conditions: Autism Spectrum Disorder

Summary: the goal of this clinical trial is to assess whether telehealth-based family navigation (fn) expedites enrollment (e.g., reduces time in days) in community-based autism intervention for black toddlers under the age of 4 after their initial diagnosis of autism. the main questions it aims to answer are: does family navigation decrease the time to initiation of intervention for black toddlers with autism? does family navigation improve developmental outcomes at 18 months post-diagnosis of autism? does family navigation improve caregiver well-being? caregivers in the family navigation condition will receive 4 research-based individual sessions with a trained navigator to support them in identifying and enrolling in recommended autism early intervention services. all navigation sessions will be delivered virtually via phone/zoom. researchers will compare participants who receive family navigation to participants who receive the standard of care (educational materials) to see if family navigation outperforms the standard of care.


Eligibility criteria:
inclusion criteria: * children up to 48 months who have a new diagnosis of autism, or who are waiting for a diagnosis of autism and their caregiver. * live in georgia or north carolina * caregiver must be over the age of 18 * their child with autism must identify as black/african-american * speak conversationally fluent english. exclusion criteria: * no access to a telephone or internet connection for phone calls or video conferencing. * diagnosis of autism spectrum disorder is ruled out in the child.
this is a study to verify if marrow venting procedure can improve meniscal suture healing

Conditions: Meniscal Tear

Summary: meniscal suture represents the current surgical practice, and marrow venting is a low risk procedure. bone venting may be able to improve the outcome of meniscal repair, allowing the patient a better recovery.

meniscal tears are one of the most common lesions of the knee and are a risk factor for the development of knee osteoarthritis. a meniscal tear commonly causes knee pain, stiffness, loss of function and sometimes catching or locking of the knee, affecting patients' ability to participate in their everyday activities. in case of ineffective conservative management, meniscal tears are treated with meniscectomy (partial or total) or meniscal repair, with the latter considered, when possible, the optimal choice. meniscal repair consists of a suture that juxtaposes the flaps of the injured meniscus to facilitate the healing of the tear. unfortunately, meniscal healing capability is limited. a higher rate of meniscal tears healing has been documented in patients treated simultaneously with a meniscal repair and anterior cruciate ligament reconstruction. a surgical augmentation technique performing micro-fractures on the medial aspect of the lateral femoral condyle during meniscal repair surgery has been developed to mimic the beneficial effect of anterior cruciate ligament reconstruction on the joint environment. this technique has been successfully tested in preclinical studies, in human cohort studies and, recently, in a randomized control trial. however, these randomised controlled trials present some methodological weaknesses, such as a low number of included patients, and included only full-thickness vertical longitudinal tears in the red-red zone, the meniscal tears with the highest healing potential. the effect of additional micro-fractures on the healing capacity of meniscal tears involving the red-white zone has never been tested.

Eligibility criteria:
inclusion criteria: * arthroscopic confirmed suturable meniscal tears, * monolateral meniscal tears, * 18-45 years, * bmi\>18,5 and \<35 kg/m2, * ability to give informed consent by signature. exclusion criteria: * bilateral meniscal tears requiring treatment, * associated ligament lesions requiring treatment, * associated cartilage lesions (outerbridge \> 2), * knee axis deformities requiring correction * generalized ligamentous laxity, * radiographic knee ostheoarthritis, * other reasons for knee pain, * pregnant or lactating women, * serious systemic diseases such as cardiac, hepatic or renal failure, rheumatic diseases, non-compensated diabetic, psychological illnesses, central or peripheral neurological diseases, and autoimmune diseases, * enrolled in another ongoing clinical trial.
intracytoplasmic morphologically selected sperm injection and advanced maternal age

Conditions: Female Infertility

Summary: the objective of this study was to evaluate the advanced maternal age as a rationale for performing intracytoplasmic morphologically selected sperm injection (imsi). this prospective randomized study included couples undergoing intracytoplasmic sperm injection (icsi) as a result of advanced maternal age (≥ 37 years old). couples were randomly allocated to receive one of two sperm selection procedures (icsi, n = 33; or imsi, n = 33). the groups were compared with regard to fertilization rate, percentage of high-quality embryos, implantation, pregnancy and miscarriage rates.


Eligibility criteria:
inclusion criteria: * good physical and mental health * advanced maternal age (≥ 37 years old) * regular menstrual cycles of 25-35 days * normal basal fsh and lh levels * body mass index less than 30 kg/m2 * presence of both ovaries * intact uterus * no hormone therapy for at least 60 days preceding the study exclusion criteria: * polycystic ovaries * endometriosis * gynaecological/medical disorders * positive result in a screening for sexually transmitted diseases

Keywords: advanced maternal age infertility imsi icsi implantation
nat2 in re-challenge of inh in patients with hepatitis

Conditions: Tuberculosis; Hepatotoxicity

Summary: apply the information of nat2 genotyping into the re-challenge protocol of inh titration in patients with anti-tb medication induced hepatitis.

adjusting inh dose according to nat2 genotyping and serum concentration of inh.

Eligibility criteria:
inclusion criteria: * older than 18 years-old * taken inh for more than 1 week * abnormal liver function exclusion criteria: * rule out the inh induced liver abnormality * existing reasons to cause liver abnormality other than tb-medication * taking drugs which interact with inh

Keywords: tuberculosis isoniazid arylamine n-acetyl transferase genotyping hepatotoxicity pharmacogenetics
effects of neuromuscular electrical stimulation as an adjunct to exercise training in stable chronic obstructive pulmonary disease (copd)

Conditions: Chronic Obstructive Pulmonary Disease (COPD)

Summary: skeletal muscle dysfunction impairs exercise capacity, quality of life and prognosis in chronic obstructive pulmonary disease (copd). the purpose of this prospective randomized controlled study was to evaluate effects of neuromuscular electrical stimulation (nmes) plus quadriceps muscle training (nmes group) and sham nmes plus quadriceps muscle training (control group) on muscle function, exercise capacity, health related quality of life, activities of daily living, and self-efficacy in patients with copd who are eligible and able to participate in endurance training.

skeletal muscle dysfunction is common and impaires exercise capacity in patients with chronic obstructive pulmonary disease (copd)exercise training is the main component of the treatment of copd. neuromuscular electrical stimulation (nmes) is successful in copd patients who are unable to perform exercise training. the nmes has positive effect on peripheral muscle function, exercise capacity and breathlessness in activities of daily living in copd patients who had an abnormal body composition or who were too dyspneic to leave their home. a nonrandomized uncontrolled study has shown that application of nmes at home for improved exercise capacity in patients with better-preserved muscle mass. evidence from a preliminary study without applying sham nmes revealed that nmes applied as complementary to ambulatory respiratory rehabilitation program increased quadriceps strength, quality of life and six minute walk distance in severe to very severe patients. despite documented benefits of nmes in copd patients, the place of nmes as an adjunct to pulmonary rehabilitation in copd patients who were able to do regular endurance and strength training on is unknown. therefore, the purpose of this study was to compare the effects of nmes plus quadriceps muscle training (nmes group) and sham nmes plus quadriceps muscle training (control group) on muscle function, dyspnea, fatigue, exercise capacity, health related quality of life, activities of daily living, and self-efficacy in patients with copd who are eligible and able to participate in endurance training.

Eligibility criteria:
inclusion criteria: * diagnosis of chronic obstructive pulmonary disease * being 35-75 years of age * being eligible to participate in endurance trainin * no acute exacerbation in last month, no change in drugs and no usage of antibiotics in last three weeks exclusion criteria: * medical conditions which could place patient at risk during neuromuscular electrical stimulation and exercise training (orthophedic and neuromuscular disorders, metal implants in the lower limbs, advanced heart failure, aortic stenosis, deep venous thrombosis a cardiac pacemaker, \>50 mmhg pulmonary artery pressure and/or an acute exacerbation of symtomps in the preceeding four weeks) * being unable to understand the questionnaires and unable to cooparate.

Keywords: copd exercise neuromuscular electrical stimulation
converge - epi/endo ablation for treatment of persistent atrial fibrillation(af)

Conditions: Persistent Atrial Fibrillation

Summary: this is a multi-center, open label, randomized pivotal study evaluating the safety and efficacy of the epi-sense-af guided coagulation system for the treatment of persistent af patients, refractory or intolerant to at least one class i and/or iii anti arrhythmic drug (aad).

the objective of this randomized pivotal study is to evaluate the safety and efficacy of the atricure epi-sense®-af guided coagulation system with visitrax® for the treatment of symptomatic persistent atrial fibrillation (af) patients, refractory or intolerant to at least one class i or class iii anti-arrhythmic drug (aad). 153 subjects from up to 27 us and 3 ous sites. randomized 2:1. the primary efficacy endpoint is success or failure to be af/at/afl free absent class i and iii aads except for a previously failed or intolerant class i or iii aad with no increase in dosage following the 3-month blanking period through the 12-month post procedure follow-up visit. the primary safety endpoint is the incidence of major adverse events (maes) listed in the protocol for subjects undergoing the convergent procedure for the procedural to 30-day post procedure time period.

Eligibility criteria:
inclusion criteria: * age \> 18 years; \< 80 years * left atrium \< 6.0 cm * refractory or intolerant to one aad (class i and/or iii) * documentation of persistent af * provided written informed consent exclusion criteria: * patients requiring concomitant surgery * left ventricular ejection fraction \< 40% * pregnant or planning to become pregnant during study * co-morbid medical conditions that limit one year life expectancy * previous cardiac surgery * history of pericarditis * previous cerebrovascular accident (cva), excluding fully resolved transient ischemic attack (tia) * patients who have active infection or sepsis * patients with esophageal ulcers strictures and varices * patients with renal dysfunction who are not on dialysis * patients who are contraindicated for anticoagulants * patients who are being treated for ventricular arrhythmias * patients who have had a previous left atrial catheter ablation for af * patients with existing implantable cardioverter-defibrillator (icds) * current participation in another clinical investigation of a medical device or a drug, or recent participation in such a study within 30 days prior to study enrollment * not competent to legally represent him or herself

Keywords: atrial fibrillation convergent procedure combined epicardial/ endocardial ablation hybrid procedure radiofrequency ablation arrhythmia rf ablation