Kornimate/medical-research-clean huggingface dataset:
a prospective cohort study of patients with hepatobiliary cancer treated with immune checkpoint inhibitors

Conditions: Hepatocellular Carcinoma; Biliary Tract Cancer

Summary: although immune checkpoint inhibitors including nivolumab and pembrolizumab are now available for the management of hepatobiliary cancers in korea, there is a lack of data for the efficacy and safety of these agents in the real-world setting. this study aims to prospectively evaluate the efficacy of safety of nivolumab and pembrolizumab against advanced hepatocellular carcinoma and biliary tract cancer.

nivolumab 3 mg/kg intravenous every 2 weeks has been recently approved by us fda for the management of patients with sorafenib-failed advanced hcc based on the promising data of checkmate-040 phase i/ii study. although there is a lack of prospective data for pembrolizumab in biliary tract cancer except for small phase 1 trial, pembrolizumab is now available for use in korea for the management of advanced biliary tract cancer. because the approval of these agents was based on the small sample size, further prospective evaluation of nivolumab or pembrolizumab in patients with hepatobiliary cancer is needed.

Eligibility criteria:
inclusion criteria: * biliary tract cancer (intrahepatic or extrahepatic cholangiocarcinoma and gallbladder cancer) or hepatocellular carcinoma * planned immune checkpoint inhibitors including nivolumab or pembrolizumab * written informed consent exclusion criteria: * not available for the treatment with immune checkpoint inhibitors
women's mammography study to improve comfort during mammography

Conditions: Pain

Summary: the purpose of this study is to determine in a randomized trial whether it is possible to decrease the discomfort of mammography by using the analgesic ibuprofen, or by using a scripted, supportive text informing patients about mammography.

this study is designed to evaluate two methods of reducing pain and discomfort caused by mammography, one of the barriers to the procedure.

Eligibility criteria:
inclusion criteria: * must have signed the informed consent. * must either be getting her first mammogram or based on prior experience be expecting level 4 or 5 pain exclusion criteria: * may not have taken ibuprofen or other pain medication within the last 12 hours. * must not have a contraindication for taking ibuprofen e.g: * no history of allergic reactions to ibuprofen or aspirin * no recent history with the last year of bleeding from gi tract * not pregnant or suspected of being pregnant

Keywords: mammogram ibuprofen pain management
mirabegron in achalasia: a clinical and manometric proof of concept pilot study

Conditions: Achalasia

Summary: this study evaluates whether a medication called mirabegron is better than placebo (sugar pill) in helping patients with achalasia swallow better. each patient will receive either mirabegron or the placebo for 4 weeks followed by the opposite medication. each patient will complete several surveys and undergo several tests to determine if the mirabegron is helping reduce the pressures in the esophagus (swallowing tube).

achalasia is characterized by incomplete or absent relaxation of the lower esophageal sphincter (les) and loss of esophageal peristalsis which leads to dysphagia. standard of care for achalasia includes endoscopic management (dilation and injection of injection of botulinum toxin) and surgery, however both of these options carry procedural risks, may lose efficacy over time and many patients are not appropriate candidates for these treatment options. unfortunately, there are limited oral medications for patients with achalasia. mirabegron is an oral beta-3 agonist currently fda approved for overactive bladder that works by relaxing the bladder muscles. beta-3 receptors have also been identified in the les with stimulation leading to les relaxation in preclinical studies. through a proof of concept pilot study, the investigators aim to evaluate the effect of mirabegron in patients with achalasia via high resolution manometry and a validated dysphagia scale.

Eligibility criteria:
inclusion criteria: * 18 years old \< age \< 75 years old with prior diagnosis of achalasia via manometry and/or radiographically exclusion criteria: * \ 75 years old * history of hypertension not controlled on oral medications (blood pressure \> 160/100 mm hg) * no prior history of hypertension with a blood pressure \> 160/100 mm hg * history of bladder outlet obstruction * history of angioedema * pregnant or breast-feeding women: women between 18 and 40 years old who are enrolled in the study will be required to use a form of birth control during the study * patients currently receiving certain medications (digoxin, warfarin, any overactive bladder medications, thioridazine, flecainide, propafenone, phosphodiesterase inhibitors) * patients with prolonged qtc interval or risk factors to develop it: * baseline qtc on ekg of \> 450 milliseconds * history of additional risk factors for torsades de pointes (heart failure, family history of long qt syndrome) * concomitant medications that prolong the qtc interval: ranolazine, sotalol, dofetilide, procainamide, disopyramide, propafenone, azole antifungals, fluoroquinolones, macrolide antibiotics, hiv antiretrovirals, chemotherapy, beta-2 agonists, tricyclic antidepressants, selective serotonin reuptake inhibitors * prior surgeries for achalasia * \< 2 months since last endoscopic botulinum toxin injection into les or endoscopic dilation * stage 4 chronic kidney disease (severe renal impairment with gfr 15-29 ml/min), stage 5 chronic kidney disease (gfr \< 15 ml/min or on dialysis) * childs pugh b (moderate) or c (severe) cirrhotic (hepatic impairment)
asan multivessel registry

Conditions: Coronary Artery Disease

Summary: the purpose of this study is to evaluate long-term prognoses of patients with multivessel coronary disease treated medically or surgically or percutaneously in real world practice.


Eligibility criteria:
inclusion criteria: * patients with multivessel disease from 1995 in asan medical center * age 19 and more exclusion criteria: * for prospective cohort, not agreeing to participate with written informed consent form

Keywords: multivessel
stroke volume variation-guided fluid infusion in major liver tumour resection

Conditions: Fluid Management

Summary: studies have demonstrated that the rate of change in stroke volume variation (svv) can be used to determine the volume of body fluids during major abdominal surgery. anaesthesiologists can use svv as a guide for the appropriate administration of intraoperative fluids to improve postoperative prognoses. liver surgery is a major abdominal operation, and the amount of blood lost is typically higher than that during other general abdominal surgeries. blood loss is positively correlated with the intraoperative fluid infusion volume, and greater blood loss is associated with more postoperative complications. additionally, comorbid liver disease or cirrhosis can increase the complexity of liver tumour resection, causing difficulty in assessing intravascular volume and determining the appropriate intraoperative infusion volume.


Eligibility criteria:
inclusion criteria: * we initially selected 118 patients who required hepatectomy. * the physiological status of the patients was assessed in terms of american society of anesthesiologists scores i-iii exclusion criteria: * extreme body mass index (bmi) * age under 20 or over 75 years * emergency surgery * preexisting cardiac, hepatic, renal, or coagulation disorder; hyperthyroidism; and sinus arrhythmia.

Keywords: stroke volume variation fluid therapy hepatectomy alanine aminotransferase estimated glomerular filtration rate
a cross-sectional study of covid-19 pandemic in zhejiang province

Conditions: Cross-sectional Study; COVID-19 Pandemic

Summary: this study adopted a cross-sectional study, collected the medical history and symptoms of patients infected with covid-19 through a questionnaire survey, and made statistical analysis, so as to provide better clinical guidance.

recently, there has been an outbreak of covid-19 in zhejiang province. in order to comprehensively understand the condition of patients with covid-19 in zhejiang province, this study adopted a cross-sectional study, collected the medical history and symptoms of patients infected with covid-19 through a questionnaire survey, and made statistical analysis, so as to provide better clinical guidance.

Eligibility criteria:
inclusion criteria: * a positive nucleic acid test for covid-19, or a positive antigen test for novel coronavirus, no age limit. exclusion criteria: * unable to understand the contents of the questionnaire for various reasons

Keywords: cross-sectional study covid-19 pandemic
lasers in onychomycosis

Conditions: Onychomycosis

Summary: onychomycosis is the most common nail disease, representing more than 50% of all onychopathies. future studies on the absorption spectra of dermatophyte fungi will be needed to develop lasers that effectively exploit absorption differences in fungi and dermal tissue.

treatments with antifungals may not be successful due to several factors, including the long time required to apply topical medications, the side effects of systemic drugs, and the application of insufficient medication to the target area. even with adequate systemic or topical therapy, the persistence of fungal infections is not uncommon. in light of these limitations, laser therapy has been proposed as an alternative option for onychomycosis therapy.

Eligibility criteria:
inclusion criteria: * patients with onychomycosis. exclusion criteria: * patients with excessive manual work
benefits of dry needling in trigger points on autonomic nervous system and corporal composition in patients with fibromyalgia syndrome

Conditions: Fibromyalgia; Trigger Points

Summary: this study evaluates the benefits of dry needling in trigger points on autonomic nervous system, photoelectric plethysmography, body composition in patients with fibromyalgia syndrome.

dru needling can be developed on active trigger points. myofascial trigger points can be active or latent. an active myofascial trigger point pain causes giving a specific pathological picture. we will conduct a location of myofascial trigger points following the illustrations location myofascial trigger points that indicate travell and simons both left-sided and right.

Eligibility criteria:
inclusion criteria: * fibromyalgia syndrome diagnosis. * aged from 18 to 65 years. * no regular physical activity. * limitation of usual activities due to pain on at least 1 day in the previous 30 days. * agreement to attend evening therapy sessions. exclusion criteria: * severe physical disability. * comorbid conditions (eg, morbid obesity, inflammatory diseases, irritable bowel syndrome, interstitial cystitis). * uncontrolled endocrine disorders (eg, hyperthyroidism or hypothyroidism, diabetes). * malignancy. * psychiatric. * illnesses (eg, schizophrenia or substance abuse). * medication usage other than as-needed analgesics (excluding long-term narcotics). * history of surgery. * history of whiplash injury. * presence of a score \>9 points in the beck depression inventory.

Keywords: body composition autonomic nervous system oxygen randomized controlled trial
all eyes on pcs - analysis of the retinal microvasculature in patients with post-covid-19 syndrome

Conditions: Long Covid19; Post COVID-19 Condition; Endothelial Dysfunction

Summary: the goal of this observational, prospective study is to in depth analyze the retinal microvasculature in patients with post-covid-19 syndrome (pcs). the main questions it aims to answer is: do patients with pcs show a prolonged endothelial dysfunction when compared with fully covid-19 recovered participants? does symptom severity in pcs patients correlate with the extend of endothelial dysfunction? do these changes correlate with improvement in symptoms in the prospective observation?

the investigators will recruit patients with pcs, fully covid-19 recovered participants and covid-19 infection naïve participants. after comprehensive clarification and given written informed consent, measurements will take place in the klinikum rechts der isar. to evaluate the retinal microvasculature dynamic retinal vessel analysis (dva) and optical coherence tomography (oct) are used. patient reported outcomes (prom) of pcs typical symptoms will be collected using standardized questionnaires. to ensure data quality the investigators will use standard operating procedures (sop) for both technical measurements and data collection. for dva measurements all examiners will be trained by a single experienced supervisor and must reach high image accuracy and quality in at least 10 volunteers. examiners are only involved in data acquisition.

Eligibility criteria:
inclusion criteria: * patients with post-covid syndrome (positive pcr or positive rapid antibody test ≥3 months) with a currently existing, pcs-typical complaint complex, ongoing for at least 2 months and cannot be explained by an alternative diagnosis. * control group: recovered from covid-19 infection (positive pcr or positive rapid antibody test ≥ 3 months) without residual symptoms. * healthy cohort: no history of covid-19 infection exclusion criteria: * missing or incomplete consent form * age \< 18 years * pregnancy * malignancy * diseases associated with a significant change in life expectancy * autoimmune diseases of the rheumatological type * cataract * epilepsy * glaucoma

Keywords: retinal vessel analysis retinal microvasculature autoimmunity inflammation vasculopathy
establishment of an anaesthetic protocol for examinations for children with glaucoma or suspected glaucoma

Conditions: Anesthesia; Intraocular Pressure; Glaucoma, Suspect; Pediatric Glaucoma

Summary: correct measurement of the intraocular pressure of children with glaucoma or suspected glaucoma is essential for diagnosis and therapy. despite new non-invasive measurement methods most of the children are uncooperative during the ophthalmological examination. therefore examination under anaesthesia is needed. a lot of perioperative factors influence the measurement of intraocular pressure. established and safe anaesthetic regimes have been modified regarding these factors. aim of the study is to evaluate, if a standardized anaesthetic protocol generates reliable and reproducible measured values.


Eligibility criteria:
inclusion criteria: * indication for a general anesthesia (laryngeal mask) and ophthalmological examination and probably surgery * children with glaucoma or suspected glaucoma * asa classification i-iii * written informed consent of the legal representatives exclusion criteria: * contraindication for a laryngeal mask airway * known allergy to propofol or remifentanil
reduction of venous emboli load after breathing normobaric oxygen compared to air

Conditions: Hyperbaric; Diving Medicine; Decompression Sickness; Central Nervous Injury; Inflammation; Endothelial Dysfunction

Summary: primary objective: - assessment of venous gas emboli load post diving when breathing normobaric oxygen compared to air. secondary objective: * assessment of fluid markers of central nervous system injury in blood post diving * assessment of fluid markers of inflammation and endothelial dysfunction in blood post diving tertiary objective: - assessment of dcs frequency

this is a prospective, double blinded, randomized, cross-over study in sweden. the study was performed in two different sets, each containing standardized dives in a wet hyperbaric chamber. the dives included movement on depth. in each study set 16-32 professional divers performed no-decompression dives to a depth of 42 metres of seawater (msw). the gas used during the dives was compressed air. after surfacing the divers breathed either normobaric oxygen or normobaric air on a demand mask. timing of oxygen/air-breathing differed between study sets. the content of breathing gas was unknown to both divers and examining personnel. immediately post dive the divers were assessed using either transthoracic doppler ultrasound (ttd) or transthoracic 2-d ultrasound (tte) to determine vge load, time to vge detection and vge duration. signs of dcs were actively sought. ttd measurements were done every five minutes during the first 30 minutes, thereafter every 15 minutes during 90 minutes. tte was performed every 30 minutes, using an apical 4-chamber view. blood samples were obtained pre-dive, 30-45 minutes post-dive and 120 minutes post-dive. set 1: 16 divers, divided into two equal groups (a and b). dive to 42 msw during 10 min with a safety stop at five msw during three min. immediately post dive breathing of oxygen (group a) or air (group b) during 30 min. vge load, time to vge detection and vge duration is recorded. blood samples were obtained pre-dive and 30 and 120 minutes post-dive. after 48 hours, the dives were repeated with switched gases between the groups. set 2: 32 divers, divided into two equal groups (a and b). dive to 42 msw during 10 min with a safety stop at five msw during three min. fifteen minutes post dive breathing of oxygen (group a) or air (group b) during 30 min. vge load, time to vge detection and vge duration is recorded. blood samples were obtained pre-dive and 45 and 120 minutes post-dive, from the first 16 divers. after 48 hours, the dives were repeated with switched gases between the groups. two further planned sets with repeated diving and shorter duration of oxygen/air-breathing were never carried through. ae including sae will be recorded during the study. dcs may be considered either an ae or sae depending on severity. ongoing ae and sae will be followed up.

Eligibility criteria:
inclusion criteria: * professional diver * fit to dive according to swedish navy standards exclusion criteria: * none
carbetocin versus rectal misoprostol for management of third stage of labor in women at low risk of postpartum hemorrhage

Conditions: Postpartum Hemorrhage

Summary: 150 pregnant women admitted for spontaneous, induced or augmented vaginal delivery and categorized as low risk for postpartum hemorrhage (pph) were divided randomly into two groups. carbetocin group (c) received 1 ampoule of carbetocin (100 μg/ml) (pabal®, draxis/multipharma, egypt, under license from draxis pharma-canada) added to 10 cc saline and given iv after the delivery of the baby. misoprostol group (m) received 2 rectal misoprostol tablets (800 μg) (misotac; sigma pharm, cairo, egypt) after the delivery of the baby. blood samples were tested to measure hemoglobin levels upon admission to the labor room and 12 hours after delivery

150 pregnant women admitted for spontaneous, induced or augmented vaginal delivery and categorized as low risk for postpartum hemorrhage (pph) were divided randomly into two groups. carbetocin group (c) received 1 ampoule of carbetocin (100 μg/ml) (pabal®, draxis/multipharma, egypt, under license from draxis pharma-canada) added to 10 cc saline and given iv after the delivery of the baby. misoprostol group (m) received 2 rectal misoprostol tablets (800 μg) (misotac; sigma pharm, cairo, egypt) after the delivery of the baby. blood samples were tested to measure hemoglobin levels upon admission to the labor room and 12 hours after delivery

Eligibility criteria:
inclusion criteria: singleton pregnancy 36-40 weeks of gestation vertex presentation. normotensive hemoglobinlevel \> 10 gm/dl • noncomplicated pregnancy exclusion criteria: * women with history of postpartum hemorrhage in previous deliveries uterine fibroids previous cesarean section medical disorders (e.g. diabetes, anemia, coagulation disorders, cardiac, hepatic and renal diseases) antepartum hemorrhage
evaluation of alerts in promoting bone densitometry scans

Conditions: Bone Diseases; Communication

Summary: the purpose of this study is to assess, prospectively, the effect of provider-facing alerts for bone densitometry scans with and without a single-click best practice alert (bpa) on scan orders and completions. the investigators hypothesize that the remaining alerts left in place (via health maintenance topics and an actionable item in the electronic health record sidebar) will be as effective without the bpa compared to the alerts with a bpa.

standard care for bone densitometry scans at geisinger--i.e., dual-energy x-ray absorptiometry (dxa) scans--involves (1) an alert under the health maintenance topics tab in epic, (2) an actionable item in a sidebar (storyboard), (3) and a single-click best practice alert (bpa). storyboard and the bpa theoretically serve a redundant function, but it is possible that combined alerting is effective. therefore, the investigators plan to evaluate whether the bpa for dxa scans will increase the percentage of dxa scans ordered and completed. for this evaluation, the investigators will randomly assign (by odd and even mrn) half of patients who need dxa scans to go through standard care (including the single-click bpa) and half of patients to have no bpa shown to their provider, but only the health maintenance topic and actionable storyboard alert. this evaluation will help the investigators determine whether redundant, more traditional alerts such as bpas are helpful or can be removed from alerts for dxa scans. the randomization of patients to different alert conditions will be in place until 4,200 participants have been reached (estimated sample to detect 4% absolute difference, rounded to nearest hundred) or 6 months, whichever comes first. to account for delays in updating clinical databases, the outcome data will pulled 3 months after each encounter (for a maximum study period of 9 months). the main analysis will use a logistic regression to compare the two groups. exploratory analyses will also examine the time from order to completion to examine any effect on timing between arms. another set of exploratory analyses will also examine the number of other bpas firing to see if alert fatigue influenced the number of orders or completions or interacted with the experimental conditions.

Eligibility criteria:
inclusion criteria: * in primary care * records indicate patient is due for a bone densitometry scan (generally, a high-risk patient that requires this scan or age 65 and older) exclusion criteria: * encounters at clinics/sites where the randomization build cannot easily be deployed

Keywords: bone diseases alerts densitometry dual energy x-ray absorptiometry scan
nifedipine vs placebo for maintenance tocolysis of preterm labor.

Conditions: Obstetric Labor, Premature; Venous Thrombosis

Summary: comparing nifedipine to placebo for the maintenance tocolysis of preterm labor

to estimate whether maintenance nifedipine tocolysis after arrested preterm labor prolongs pregnancy and improves neonatal outcomes.

Eligibility criteria:
inclusion criteria: - arrested preterm labor exclusion criteria: - ruptured membranes, fetal distress, placenta previa, placental abruption, maternal medical contraindication to tocolysis