Kornimate/medical-research-clean huggingface dataset:
transluminal flexible endoscopic procedure in foregut and urologic surgery

Conditions: Gastric Foreign Body, Nos; Disorder of Abdomen (Disorder); Foreign Body in Esophagus; Prostatic Diseases; Disease of Small Intestine

Summary: notes access is safe and feasible in the controlled human setting and comparable to standard-of-care surgical techniques. notes exploration of the abdomen provides adequate visualization comparable to laparoscopy.

this is a prospective clinical trial to evaluate the feasibility of obtaining peritoneal cavity access from natural orifice translumenal endoscopic surgery (notes) during combined laparoscopic-endoscopic foregut surgery. post-operative course will be compared with a historical chart-review control group of patients undergoing standard laparoscopic foregut and urologic surgery. the study group will be compiled by open enrollment for male and female adult subjects scheduled for combined laparoscopic-endoscopic surgery of the stomach, abdominal esophagus, prostate, bladder, proximal small intestine or who meet inclusion and exclusion criteria. the historical chart-review control group will be randomly chosen from patients from 2003-2006 having undergone combined laparoscopic-endoscopic surgery of the foregut, prostate, or bladder and as determined by cpt coding. the purpose of the study is to determine if notes access and abdominal exploration is feasible, safe, offers comparable visualization to laparoscopy in a controlled human setting.

Eligibility criteria:
inclusion criteria: * patients undergoing an already combined laparoscopic and endoscopic foregut procedure with general anesthesia * patients undergoing a prostatectomy or cystectomy with general anesthesia * all patients will have a planned gastrotomy for exploration, foreign body removal, or removal of tissue, making it a contaminated case or a planned cystotomy or urethrotomy for exploration, foreign body removal or removal of tissue such as prostatectomy or bladder resection. * no overwhelming medical co-morbidities * subject is 18 years of age or older * subject is his or her own medical decision maker * subject agrees to participate, fully understands content of informed consent form, and signs the informed consent form exclusion criteria: * patients undergoing a non-palliative procedure in the face of resectable adenocarcinoma of the foregut or genitourinary tract * linitis plastica * evidence of active bowel obstruction * patients with history of oropharyngeal, esophageal, or gastric adenocarcinoma. * esophageal stricture prohibiting passage of an endoscope * urethral stricture prohibiting passage of an endoscope * emergent surgery * at any time during pre-operative or intra-operative periods, evidence of unresectability is demonstrated * any intra-operative condition prior to surgical resection that results in abortion of the surgical procedure * any contraindication to surgery * pregnancy or actively breastfeeding women * prisoners or wards of state

Keywords: laparoscopic surgical procedures endoscopic surgical procedures laparoscopic & endoscopic procedures with a gastrotomy or opening in bladder or urethra
anatomical resection of liver metastases in patients with ras-mutated colorectal cancer

Conditions: Colorectal Liver Metastasis

Summary: the armani trial will test the hypothesis, if an anatomic resection (ar) improves long-term outcome vs. a non-anatomical resection (nar) in patients undergoing surgery for ras-mutated colorectal liver metastasis (crlm).

despite increasing application and success of personalized treatment in medical oncology, little progress has been made in personalized surgical cancer therapy. the armani trial presents the first prospective, randomized trial to evaluate effectiveness and safety of molecular-guided resection in patients with colorectal liver metastasis (crlm). while crlm might be removed independently of the liver's segmental borders, retrospective data favor anatomic resections in the subgroup of patients with a mutation in the ras oncogene. therefore, the armani trial will test the hypothesis, if an anatomic resection (ar) improves long-term outcome vs. a non-anatomical resection (nar) in patients undergoing surgery for ras-mutated crlm. the trial will be carried out among 11 high-volume centers of hepato-biliary surgery in germany. a total of 220 patients will be enrolled and randomized in a 1:1 ratio to undergo an ar vs. nar. the primary endpoint is intrahepatic disease-free survival (idfs). in addition, the study will provide important data on perioperative outcomes and quality of life for both surgical techniques. given the trend among liver surgeons to aim for parenchymal-sparing operations to preserve liver parenchyma, a positive trial will be practice changing and present the first piece of high-level evidence on benefits of personalized surgical therapy guided by the tumor's mutational profile in patients with crlm.

Eligibility criteria:
inclusion criteria: * colorectal cancer with ras mutation (kras or nras) * colorectal liver metastases (single or multiple) * planned r0 resection of liver metastases (and primary tumor, if present) * anatomical and non-anatomical liver resection technically feasible * male and female patients, age ≥ 18 years * written informed consent exclusion criteria: * extrahepatic metastases * planned staged liver resection (e.g. two-stage hepatectomy) * diagnosis of another cancer \< 5 years prior to randomization exceptions: curatively treated in situ cervical cancer, curatively resected non-melanoma skin cancer * expected lack of compliance * addiction or other illnesses which do not allow the person concerned to assess the nature and extent of the clinical trial and its possible consequences
the efficacy and economics of exercise maintenance post-cardiac rehabilitation

Conditions: Coronary Artery Disease

Summary: the purpose of this study is to develop a new intervention to improve the transition of patients from structured, supervised exercise to self-managed home- or approved community-based exercise programs in an effort to increase maintenance of exercise behaviour post cardiac rehabilitation (cr). the goal of the study is that those receiving the intervention will engage in at least 30 minutes of physical activity at a moderate or vigorous intensity 5 or more days per week, 26, 52 and 78 weeks after cr compared to those in the usual care group. the new intervention will be delivered by trained exercise facilitators (physiotherapists or exercise specialists) and will make use of: small group counseling teleconferences (5 sessions); personal telephone contacts (3 sessions), and community program demonstrations that would facilitate linkages between patients and approved community programs known as heart wise exercise programs available in ottawa and toronto. the trial will be conducted at the minto prevention and rehabilitation centre at the university of ottawa heart institute and the cardiovascular rehabilitation and prevention centre at the university health network (peter munk cardiac centre \[pmcc\] and toronto rehabilitation institute \[tri\]) sites. the study has a target enrollment of 604 participants.


Eligibility criteria:
inclusion criteria: * patient is currently participating in an on-site cr program of ≥ 8-week duration (to ensure that outcomes are not confounded by exposure to home-based or telephone-based case managed programs) * patient has graduated from cr (to ensure that the study is evaluating an intervention to help sustain and improve maintenance of exercise behaviour * patient has a documented diagnosis of cad (to ensure homogeneity of the patient population) * patient is 18 years of age or older * patient is able and willing to provide informed consent * able to walk unaided at 2 mph exclusion criteria: * patient has new york heart association class iii or iv heart failure (because this might interfere with the ability to achieve recommended exercise levels and to ensure homogeneity of the patient population) * patient is pregnant, lactating or planning to become pregnant during the study period (because this might interfere with the ability to achieve recommended exercise levels) * patient is unable to read and understand english or french * planning to leave the province or region in the next 12 months * member of the participant's household is already participating in the study * the participant is unable, in the opinion of the qualified investigator, to participate in unsupervised exercise.

Keywords: coronary artery disease cardiac rehabilitation exercise maintenance facilitator managed home exercise community based exercise
pulmonary capillary recruitment in fontan patients

Conditions: Congenital Heart Disease

Summary: this study evaluates the effects of pulmonary vasodilator therapy on pulmonary capillary blood flow by measuring the functional capillary surface area (fcsa) at baseline and post nitric oxide inhalation, through the injection of 3h-benzoyl-phe-ala-pro (bpap). fcsa will be related to flow and other hemodynamic parameters in order to determine if there is capillary recruitment or distention in fontan patients. we will also compare baseline fcsa measurements with previously studied normal subjects, to assess the difference in hemodynamic pulmonary functional parameters between these single ventricle physiology patients and normal subjects.


Eligibility criteria:
inclusion criteria: fontan failures will be defined as patients with single ventricle physiology and tcpc with clinical signs of dysfunction defined as any of the following: 1. decreased functional class who/nyha ii or more and clinical signs of congestion (ascites, peripheral edema, increased jvp) and/or nt-probnp \> 399 pg/ml based on \[17\]. 2. age \> 18 years 3. known fontan's increased pressures a. fontan mean pressure of ≥15 mmhg and/or transpulmonary gradient ≥ 5 mmhg. b. pulmonary vascular resistance ≥ 2 woods units. and/or supporting evidence of end-organ damage 1. clinical or paraclinical evidence of liver congestion and/or fibrosis a. evidence in ultrasound or other imaging techniques of liver congestion and/or changes related to cardiac cirrhosis. b. fibroscan with grade 2 or + 2. paraclinical signs of portal hypertension defined as 2 or more: 1. thrombocytopenia defined as platelet count \< 150.0000 2. leukocytopenia defined as white blood cell less than 4.500 3. esophageal varices on esophagoduodenoscopy. 4. splenomegaly on imaging - exclusion criteria: 1. presence of fenestration - the shunts include veno-veno collaterals 2. significant anemia defined as hgb \< 120 mg/dl 3. pregnancy at the moment of the procedure. 4. taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. 5. usage of nitrates, phosphodiesterase inhibitors or calcium blockers within 3 months of the study. -
rebound pain after peripheral nerve blocks

Conditions: Pain; Block

Summary: in recent years, the use of regional anesthesia techniques as part of multimodal analgesia strategies to maximize pain control in patients has reduced opioid requirements and promoted early mobility and rehabilitation in the perioperative period. regional anesthesia has benefits, mainly peripheral nerve blocks (pnb), muscle relaxation, and postoperative analgesia, thus allowing for control of postoperative pain and early discharge from the hospital. in addition, using pnb techniques provides: hemodynamic stability. reduced need for a post-anesthetic care unit (pacu). reduced unplanned hospitalization for pain control. less airway management. reduced incidence of opioid-related adverse events. greater patient satisfaction the main feature of rebound pain is that it is severe pain, within 8-24 hours after pnb. it usually remains severe for 2-6 hours, but the subsequent pain trajectory is consistent with the recovery process expected at surgical intervention. therefore, rebound pain is temporary and different from persistent post-surgical pain (ppsp). rebound pain often occurs at night. however, this is probably related to the 8 to 12-hour duration of most single-injection pnbs and the completion of most elective surgeries during daylight hours.

this study aims to reveal the rebound pain profile, determine the risk factors, and contribute to developing strategies that can prevent rebound pain.

Eligibility criteria:
inclusion criteria: * patients aged \>18 years who underwent orthopedic surgery with the peripheral nerve block exclusion criteria: * patients who did not want to participate in the study * dementia * severe psychiatric or cognitive dysfunction * coagulopathy * neuropathic disorder * local anesthetic allergy * serious heart-lung disease * chronic opioid use

Keywords: rebound pain peripheral nerve blocks analgesia
effects of dextrose on knee osteoarthritis

Conditions: Physical Activity; Functional Disturbance

Summary: using double blind, randomized controlled design to study the immediate, short-term and intermediate-term therapeutic effects of ultrasound guided hyaluronic acid injection and hyaluronic acid combined dextrose injection to patients with knee osteoarthritis.

a total of 106 patients will be collected. the participants will be randomized into two groups, including hyaluronic acid group and hyaluronic acid combined dextrose group. the hyaluronic acid group will receive 3 times of hyaluronic acid injection per week in three weeks; the hyaluronic acid combined dextrose group will receive 3 times of hyaluronic acid combined dextrose injection per week in three weeks. the pain, physical activity, and functional performance will be evaluated. all the evaluations will be re-evaluated at one week after injection, one month after injection, three months after injection, and six month after injection. subjects and the evaluator will be both blinded to the group's classification during the whole course of study.

Eligibility criteria:
inclusion criteria: * knee osteoarthritis with kellgren/lawrence grade ii or iii exclusion criteria: * who have neurological deficit, such as stroke who have implant in knee

Keywords: knee osteoarthritis hyaluronic acid dextrose therapeutic effects
randomized trial comparing performance of molecular markers for indeterminate thyroid nodules

Conditions: Thyroid

Summary: the purpose of this study is to compare the performance of afirma gsc and thyroseq v.3 in indeterminate thyroid nodules to determine which test can allow more patients to avoid unnecessary surgery and preserve quality of life. in the initial phase of this study, the performance of afirma gec and thyroseq v.2 were compared.

1. all patients undergoing thyroid fna within the ucla health system will be randomized at the time of fna to a single molecular test (gsc or thyroseq v.3). in the previous phase of the study, patients were randomized to the previous versions of a single molecular test (gec or thyroseq v.2). 2. during the fna, a sample will be collected for the molecular test. 3. if the cytology results are indeterminate (bethesda categories 3 or 4), the molecular test will be reflexively sent off. 4. we will help patients with indeterminate thyroid nodules to establish care with an endocrinologist, if they do not already have one. the physicians will make treatment recommendations using best practices and incorporating the results of the molecular test. we anticipate that most patients with a positive molecular test will undergo surgery, while the majority with a negative test will be surveiled. 5. patients who undergo surgery will have histopathologic evaluation of the thyroid, which will determine whether the index thyroid nodule was benign or malignant. 6. patients who do not undergo surgery will have a followup ultrasound at 6 and 12 months, or sooner at the discretion of the treating physician. 7. we will assess thyroid-specific quality of life at baseline (following initial diagnosis of an indeterminate thyroid nodule) and during followup (at 6 and 12 months) using the short version of thyroid-related patient-reported outcome.

Eligibility criteria:
inclusion criteria: * patients with a thyroid nodule who have a thyroid biopsy performed at ucla health will be eligible for the study and consented if they agree to participate. * patients who have an indeterminate fna biopsy result (bethesda category 3 or 4) will be enrolled in the study if they agree to participate. exclusion criteria: * patients who do not have an indeterminate biopsy result (either patients who have a benign, insufficient, or malignant result).
lived experienced incontinence lived experienced incontinence - lei

Conditions: Urinary Incontinence; Experience, Life

Summary: study description: scientific literature demonstrated the negative influence of urinary incontinence (ui) on the quality of life connected to the physical, psychological, and social health of women. however, a limited number of studies investigated in depth the emotional experience of women affected by this disorder, their behaviors, and their experiences in managing the problem. health professionals need to understand these aspects to offer the best care, also taking into account women's cultural and territorial differences. research conducted on the topic in the italian context is lacking, therefore the present study aims to explore, in a northern italian context, the experience of adult women affected by ui. study design: qualitative phenomenological study (observational, cross-sectional, monocenter) objective: to explore, in a northern italian context, the experience of women aged ≥ 18 years affected by urinary incontinence (ui) study population: women ≥ 18 years old, not pregnant nor having given birth for less than 40 days, suffering from urinary incontinence who access the pelvic floor rehabilitation outpatient clinic of the san raffaele hospital in milan. sample size: women who have already had at least a couple of pelvic floor rehabilitation meetings at the outpatient clinic of the san raffaele hospital in milan, within the time frame foreseen by the study. these subjects represent a precious resource and are considered "more informative for the researcher" as they testify to the emotions and daily life that influence the symptoms of urinary incontinence, but they are also able to narrate their experience of re-education of the pelvic floor. it is assumed that approximately 20 women will be involved to reach data saturation. statistical design: the interviews will be analyzed with the hermeneutic-phenomenological ipa (interpretative phenomenological analysis) method, which involves the identification of units of meaning, categories and themes in accordance with the language of the speakers. the analysis of qualitative data will be made possible thanks to the use of data management software (nvivo). the socio-demographic data collected will be presented with absolute and relative frequencies


Eligibility criteria:
inclusion criteria: 1. female sex 2. age ≥ 18 years old 3. urinary incontinence 4. informed consent signed 5. comprehension of written and spoken italian language 6. female patients of the pelvic floor rehabilitation outclinic at san raffaele hospital exclusion criteria: 1. male sex 2. young age (\< 18 years) 3. pregnancy 4. puerperium (up to 40 days post-partum)
trial comparing cosmetic outcomes of pediatric laceration closure using skin glue, medical tape versus stitches

Conditions: Laceration

Summary: there are several methods of closing a skin cut: stitches, skin glue, and medical tape. stitches have been used for a long time to close skin cuts. skin glue (invented in the 1970s) and medical tape (invented in the 1960s) are two newer methods to close skin cuts. the purpose of this study is to find out which method (stitches, skin glue, or medical tape) of closing skin cuts results in the least amount of scarring. other things the investigators will be looking at are which method is the cheapest, which causes the least pain, which requires the least amount of sedation, and which method patients and parents like the best.

when a child comes in to the emergency room with a skin cut, if the child and their parents consent to being in the study, they will be randomly assigned to one of three groups: stitches, skin glue, or medical tape. there will be about 30 kids in each group, and thus a goal of 90 kids total in the study. in the emergency room, a lidocaine ointment will be placed on the child's cut to decrease pain. the cut will be cleaned out with sterile saline. then, depending on which method is used, the cut will be closed with either stitches, skin glue, or medical tape by their doctor. the participants will be asked to answer a short questionnaire. finally, they will be given discharge instructions and sent home. at 3 months, the investigators will call parents for a quick questionnaire over the phone and parents will be asked to take a picture of the patient's scar and send it to the study staff. once all 90 pictures have been collected, two plastic surgeons will be asked to rate the scars in terms of how they look. the plastic surgeons will not know which method was used to close which cut. once all of the scars have been rated, the averages of scars will be compared for each closure method. the investigators will also look at how much each method cost, how much extra pain medications or sedation each group used, and which method was liked best.

Eligibility criteria:
inclusion criteria: * medical complaint of laceration * single, linear laceration * laceration less than 5 cm in length and 0.5 cm in width * laceration less than 12 hours old * laceration minimally contaminated (no visible dirt in wound) * parents and child speak english exclusion criteria: * significant medical history that may impact wound healing (hematologic or oncologic diagnosis requiring chemotherapy, ichthyosis, epidermolysis bullosa, etc.) * use of oral steroids (more than 5 days in the past month) * history of keloid formation * allergy to skin glue, medical tape, or topical anesthetics * lacerations requiring deep sutures * lacerations caused by animal bites or scratches * lacerations located on the scalp, eyebrow, eyelid, lip, mucosa, joint or nail bed * no access to photographic capabilities (camera or smartphone) and/or e-mail, or unable to return to the vanderbilt children's hospital emergency room to have a picture taken at 3 months