Kornimate/medical-research-clean huggingface dataset:
covid-19 in patients with pre-existing cirrhosis (covid-cirrhosis-chess2002): a multicentre observational study

Conditions: COVID-19; Liver Cirrhosis

Summary: covid-19 pandemic with sars-cov-2 infection has become a global challenge. though most cases of covid-19 are mild, the disease can also be fatal. patients with liver cirrhosis are more susceptible to damage from sars-cov-2 infection considering their immunocompromised status. the spectrum of disease and factors that influence the disease course in covid-19 cases with liver cirrhosis are incompletely defined. this muilticentre observational study (covid-cirrhosis-chess2002) aims to study the clinical characteristics and risk factors associated with specific outcomes in covid-19 patients with pre-existing liver cirrhosis.

coronavirus disease 2019 (covid-19) pandemic with severe acute respiratory syndrome coronavirus 2 (sars-cov-2) infection has become a global challenge. though most cases of covid-19 are mild, the disease can also be fatal. patients with liver cirrhosis are more susceptible to damage from sars-cov-2 infection considering their immunocompromised status. the spectrum of disease and factors that influence the disease course in covid-19 cases with liver cirrhosis are incompletely defined. this muilticentre observational study (covid-cirrhosis-chess2002) aims to study the clinical characteristics and risk factors associated with specific outcomes in covid-19 patients with pre-existing liver cirrhosis.

Eligibility criteria:
inclusion criteria: * 1) aged 18 or above; * 2) laboratory-confirmed covid-19 infection; * 3) pre-existing liver cirrhosis based on liver biopsy or clinical findings. exclusion criteria: * 1) pregnancy or unknown pregnancy status.

Keywords: covid-19 liver cirrhosis clinical outcome
irinotecan as 3rd line therapy in gastric cancer

Conditions: Stomach Neoplasms

Summary: gastric cancer is the leading cause of cancer death in china. most patients are unresectable or metastatic disease at the time of diagnosis. systemic therapy was required for the patients with advanced stage. platinum combined with fluoropyrimidines always were considered as first line treatment. after failure of initial therapy, single agent of taxanes was used as second line treatment. however, there is no relative standard chemotherapeutic regimen in the third therapy except oral anti-angiogenesis drug-apatinib. so this study was designed to explore the role of single agent with irinotecan as third line treatment in patients with metastatic gastric cancer in china.


Eligibility criteria:
inclusion criteria: * histologically confirmed advanced or metastatic adenocarcinoma of the stomach * have failed for 2 lines of chemotherapy * life expectancy of more than 3 months * ecog performance scale ≤ 2 * at least one measurable lesion (larger than 10 mm in diameter by spiral ct scan) * duration from the last therapy is more than 6 weeks for nitroso or mitomycin * more than 4 weeks for operation or radiotherapy * more than 4 weeks for cytotoxic agents or growth inhibitors * adequate hepatic, renal, heart, and hematologic functions (platelets \> 100 × 109/l, neutrophil \> 1.5× 109/l, serum creatinine ≤ 1×upper limit of normal(uln), total bilirubin within 1× uln, and serum transaminase≤2.5×the uln). * exclusion of pregnant or lactating women exclusion criteria: * previously receiving irinotecan treatment * participated other clinical trials within 4 weeks * known gilbert syndrome or other biliary tract obstructive disease * history of other malignancies except cured basal cell carcinoma of skin and carcinoma in-situ of uterine cervix * evidence of cns metastasis * intercurrence with one of the following: hypertension, coronary artery disease, arrhythmia and heart failure * receiving the therapy of thrombolysis or anticoagulation * disability of serious uncontrolled intercurrence infection. * uncontrolled pleural effusion and ascites

Keywords: chemotherapy, metastatic gastric cancer, irinotecan
influence of shunt occlusion on organ functions in hyperammonemic patients with cirrhosis having porto-systemic shunt.

Conditions: Cirrhosis

Summary: the spontaneous porto-systemic shunt is occluded by intervention procedures like balloon occluded retrograde transvenous obliteration (brto), plug-assisted retrograde transvenous obliteration (parto) and shunt occlusion procedures resulting in diversion of blood flow towards the portal circulation and in turn the liver. according to this investigator hypothesized that shunt occlusion improves liver volume and function along with beneficial effect on other organ systems by decreasing ammonia and improving hepatopetal flow. all patients with cirrhosis having large shunt(\>10mm) and raised ammonia levels and will be randomized to receive standard medical treatment and those receiving shunt occlusion procedures. investigator will assess organ functions and liver regenerative potential pre and post (after 3 to 15 months) procedure.


Eligibility criteria:
inclusion criteria: * informed consent to participate in the study * age 18 to 70 years * cirrhotic patients with large shunts (\>10mm) and hyperammonemia (arterial ammonia \>1.5 x n) exclusion criteria: * intractable ascites * hepatocellular carcinoma * portal vein thrombosis or splenic vein thrombosis * high risk esophageal varices * pregnant and lactation * significant heart or respiratory failure * active gastrointestinal bleeding * refusal to participate in study
the impact of respiratory muscle training and patient education on chronic constipation outcomes

Conditions: Constipation; Constipation - Functional; Dyssynergia

Summary: the primary aim of this study will be to determine if a respiratory muscle training program that includes both inspiratory muscle training (imt) and expiratory muscle training (emt), targeted at improving respiratory muscle performance-based measures combined with patient education about breathing on the toilet will improve patient satisfaction scores in individuals with chronic constipation (cc).


Eligibility criteria:
inclusion criteria: * adults \>18 years of age * complaint of cc and associated symptoms * willing and able to sign an informed consent * the ability to comply with study guidelines * report two or more of the following: straining during more than 25% of defecations, lumpy or hard stools more than 25% of defecations, sensations of incomplete bowel evacuation more than 25% of defecations, manual maneuvers to facilitate more than 25% of defecations, sensation of anorectal obstruction/blockage more than 25% of defecations, and fewer than 3 small bowel movements per week. exclusion criteria: * rectal prolapse greater than grade 2 * pregnancy * cognitive impairments * currently receiving physical therapy treatment for conditions associated with pelvic floor muscle dysfunction * recent surgery within the past 3 months without clearance from a medical doctor * medication usage that would interfere with their ability to exercise safely * individuals recovering from a confirmed eating disorder * recent unexplained weight loss \>10lbs within one month.

Keywords: pelvic floor dysfunction dyssynergic defecation
rectal administration of opioids using the macy catheter in reducing pain in patients with advanced cancer

Conditions: Advanced Malignant Neoplasm; Pain

Summary: this trial studies how well rectal administration of opioids using the macy catheter works in reducing pain in patients with cancer that has spread to other anatomic sites or is no longer responding to treatment. rectal administration of opioids using the macy catheter may help to reduce the cost of care, resolve the issue of medication availability currently faced in the form of parenteral opioid shortage throughout the country, and provide adequate comfort and symptom relief for patients with smoother transition out of hospital.

primary objectives: i. determine the feasibility of using the device 'macy catheter' for rectal administration of opioids for comfort in cancer patients on palliative care. secondary objectives: i. to determine the ease of use, level of satisfaction and overall perception of effectiveness of 'macy catheter' for rectal administration of opioids for pain control in advanced cancer patients, by the hospital bedside nursing staff. ii. to assess patients' (or primary care-giver's) experience of using the 'macy catheter' 48 hours after discharge from the hospital. iii. to assess the hospice staff (or primary care-giver's) experience of using the 'macy catheter' after patient's death. outline: patients undergo placement of rectal catheter and receive opioids through the macy catheter.

Eligibility criteria:
inclusion criteria: * adult patients admitted to the inpatient acute palliative care unit (apcu) at md anderson cancer center * candidate for taking short acting opioids and/or methadone, with or without transdermal fentanyl, for control of cancer related pain * impaired oral/gastrointestinal (gi) route for medicine intake (due to, but not limited to, any level of gastrointestinal obstruction, severe nausea and/or vomiting, odynophagia and/or dysphagia due to severe mucositis, tumor, muscle weakness or in-coordination) * advanced cancer defined as cancer with no further oncological management and patients are at end of life (eol) or recommended for best supportive/comfort care (estimated prognosis less than 6 months) * able and willing to read and sign in english exclusion criteria: * non-english speaking * contraindications to use of the macy catheter (1. not be used for patients with rectal lesions, tumors, active rectal bleeding and/or compromised rectal mucosa \[i.e. ulceration or ischemic proctitis\], 2. patients with diarrhea, or more than 1 liquid stool per day, 3. patients with recent bowel surgery \[less than 6 weeks\], 4. thrombocytopenia \[platelet count less than 20,000, checked in the last 1 week\]) * patients who are unable to take oral medications due to severe constipation only, which can be adequately managed by bowel laxative regimen
a study of neurovax™, a therapeutic tcr peptide vaccine for spms of multiple sclerosis

Conditions: Secondary Progress Multiple Sclerosis; Multiple Sclerosis

Summary: multi-center, randomized , double-blind, placebo-controlled , two arm parallel design study of neurovax™ vs. incomplete freund's adjuvant ( i f a) placebo. 200 subjects with secondary progressive spms

objectives:the primary objective is to compare between treatment groups the cumulative number of new gadolinium enhancing (gd+) lesions on brain mri at weeks 24, 32, 40 and 48 i n subjects with secondary progressive ms. secondary objectives include additional mri measurements, analyses of clinical relapses, measures of neurologic disability, immunologic evaluations, and safety. study design: multi-center, randomized , double-blind, placebo-controlled , two arm parallel design study of neurovax™ vs. incomplete freund's adjuvant ( i f a) placebo. subject population: 200 subjects with secondary progressive spms ms, with an edss score \>= 3.5 , and meeting all inclusion/exclusion criteria, will be enroll in this study. subjects will be randomized equally to neurovax™ or i f a ,1 0 0 per arm .

Eligibility criteria:
inclusion criteria: * subject is between 18 and 50 years of age, inclusive. * definite ms by the revised mcdonald criteria (2005) (appendix a), with a secondary progressive course. * expanded disability status scale (edss) \>=score 3.5 (appendix b). * two or more documented clinical relapses of ms in the preceding 24 months or one documented clinical relapse of ms in the preceding 1 2 months prior to screening . * laboratory values within the following limits: * creatinine 1 . 5 x high normal. * hemoglobin

Keywords: secondary progress multiple sclerosis spms multiple sclerosis neurovax
evaluation of robot-assisted intracorporeal urinary reconstruction

Conditions: Urothelial Carcinoma; Cystectomy; Urinary Diversion; Complication of Surgical Procedure; Complication, Postoperative; Neobladder; Ileal Conduit; Robotic Surgical Procedures

Summary: continous evaluation of clinical and oncologic outcome of robot-assisted cystectomy with intracorporeal reconstruction of urinary diversion. patient data is entered in an anonymized registry for analyzation.

the registry includes patients after robot-assisted cystectomy, mainly as therapy for muscle invasive urothelial carcinoma. the urinary diversion will be completed intracorporeal either as ileal conduit or ileal neobladder. outcome parameters include perioperative complications, oncologic data and oncologic follow-up data (tumor classification, recurrence, survival) as well as data on functional follow up (continence, quality of life).

Eligibility criteria:
inclusion criteria: * age 18 years * informed consent for operation and data use * oncologic patients that qualify for radical cystectomy according to institutional tumor-board decision or patients with functional indications after failure of all other therapy modalities and receive a cystectomy exclusion criteria: * age \<18 years * declined informed consent / data use * pregnancy
continuous cardiac arrhythmia monitoring in hemodialysis patients

Conditions: Arrhythmias, Cardiac

Summary: hemodialysis patients have a rate of fatal arrhythmias that is 40 times greater than the general population, but the causes and types of fatal arrhythmias they experience is unclear. the purpose of this prospective observational cohort study is to capture and characterize occult arrhythmias which occur in hemodialysis patients over a 6 month period. after informed consent and baseline assessment, 30 adult hemodialysis patients without a prior history of cardiac arrhythmias will undergo implantation of a continuous cardiac monitoring device (reveal, medtronic). three followup visits will be scheduled to download device data and quantify the number of potentially malignant arrhythmias which occur in study subjects during the 6 month period. additionally, captured events will be monitored remotely via regular patient initiated transmission of device data every 2 weeks. any serious occult arrhythmias detected will be immediately acted upon with a predefined management algorithm. descriptive data and simple proportions will be used to describe the incidence and types of arrhythmias among the study cohort. risks of this study include 1) potential loss of patient confidentiality 2) risks related to insertion of device including pocket hematoma, device infection, pain and discomfort secondary to procedure. these will be minimized by strict security measures to protect each patient's protected health information (phi), preprocedural screening and insertion of monitoring devices by highly trained operators, and frequent careful direct patient followup.


Eligibility criteria:
inclusion criteria: * greater than 18 years of age * esrd receiving hemodialysis for at least 3 months exclusion criteria: * inability to give informed consent * pre-existing implantable cardiac device (pacemaker or icd) or imminent device implantation * imminent renal transplantation * life expectancy \< 1yr * pt-inr or aptt \> 1.7 upper limit of normal (uln) or history of bleeding diathesis * unstable medical condition as deemed by primary nephrologist or study staff * known sustained ventricular tachycardia due to non-reversible cause. * active infection * known atrial fibrillation * women who are pregnant

Keywords: end-stage renal disease hemodialysis cardiac arrhythmias
free fatty acid induced insulin resistance

Conditions: Insulin Resistance

Summary: this study aims to explore time-dependent effects of lipid infusion an intramyocellular lipid metabolites and the induction of impaired insulin signaling.

increased availability of free fatty acids impairs glucose disposal in young healthy humans. patients with type 2 diabetes have reduced whole body glucose disposal, increased ectopic lipid deposition in skeletal muscle and the liver and impaired mitochondrial function. recent studies suggest that lipid metabolites such as diacylglycerol (dag), ceramides and long-chain acyl-coa represent the active mediators inducing insulin resistance. possible targets are dag-sensitive proteinkinase c (pkc θ, pkc ε) which inhibit the insulin signaling cascade and ceramides which interfere with the insulin signaling cascade at proteinkinase b/akt. prior studies raised controvesial evidence, thus, it is yet unclear, whether dag or ceramides are the primary agents inducig lipid-induced insulin resistance. therefore, the current study aims to explore the time course of the appearance of intramyocellular lipid compunds during lipid infusion in parallel assessing markers of impaired insulin action.

Eligibility criteria:
inclusion criteria: * non-diabetic (ogtt), no family history of diabetes, bmi\<30 kg/m2, age: 20-55 years, no medication for the athletes group additionally: * vo2max \> 60ml/kg/min for males and vo2max \> 45ml/kg/min for females active in endurance-exercise activities, 3 times a week for at least 2 years stable level of training for at least 3 months exclusion criteria: * acute illness within the last 2 weeks, autoimmune diseases, renal insufficiency (creatinine\> 1.5 mg/dl), cardiovascular diseases, anemia (hb\< 12g/l), donation of blood within the last 4 weeks before the study, thyroid diseases, pregnancy, smoking, night-shift working (disturbed circadian rhythm), defective coagulation or wound healing, cancer, allergy against soja products

Keywords: ffa insulin resistance mitochondria
clinical and radiological prognostic factors of acute necrotizing encephalopathy in sohag university hospital

Conditions: Acute Necrotizing Encephalopathy

Summary: acute necrotizing encephalopathy of childhood (anec) is a fulminant type of encephalopathy. most reported cases occur in asian children with the highest prevalence among patients between the age of 6 and 18 months. the most common clinical presentations are fever, rapid alteration in the level of consciousness, and seizures, in addition to characteristic findings in brain imaging that include, but are not limited to, bilateral thalamic lesions with supra and infra-tentorial lesions of variable dimensions. the diagnosis of anec was determined by specific diagnostic criteria as described by mizuguchi \[1\] which consist of 1. encephalopathy preceded by viral febrile illness with rapid deterioration in the level of consciousness and convulsions. 2. absent cerebrospinal fluid (csf) pleocytosis. 3. symmetric multifocal brain lesions. 4. elevation in serum aminotransferase levels. 5. exclusion of similar diseases. the ane severity score was used to assess the severity of illness after admission for shock (3 points), brainstem lesions (2 points), age \>4 years (2 points), platelet (plt) count \< 100,000 (1 point), and elevated csf protein (1 point) was observed. \[3\] a total score of 9


Eligibility criteria:
inclusion criteria: - children aged from 2months up to 12 years admitted to the pediatric emergency department or pediatric icu presented with acute encephalopathy \& meet diagnostic criteria of acute necrotizing encephalopathy or come for follow up in our outpatient clinic. exclusion criteria: * children known to have metabolic disease. children who have picture of cns infection \& confirmed by csf analysis.
vancomycin prophylaxis in recurrent clostridium difficile infection

Conditions: Clostridium Difficile Infection

Summary: we are doing this research study to determine if taking vancomycin in addition to a broad-spectrum antibiotic will decrease the chance of developing recurrent clostridium difficile infection.

to determine whether prophylactic use of oral vancomycin reduces the incidence of recurrent clostridium difficile infection (rcdi) in hospitalized patients admitted from their home or another health care facility (hcf) who are exposed to concurrent broad spectrum antibiotics. this is a randomized research study, which means that the treatment you get will be chosen by chance, like flipping a coin. you will have a 50/50 chance of receiving one of the following: 1. group 1 (treatment group): single daily dose of vancomycin in liquid form (study medication). 2. group 2 (placebo group): single daily dose of placebo (a placebo will look just like the study medication, but contains no medication, only a substance like sterile water). depending on the group you are placed in (which is chosen by a computer), you will receive either a daily dose of the study medication or a daily dose of the placebo for a total of ten days. if you are discharged from the hospital prior to ten days, you will be given the study medication to complete outside of the hospital with written instructions. a member of the research staff will monitor you daily during the 10 days of treatment for any adverse reactions or any signs and symptoms of recurrent clostridium difficile infection. if you are discharged prior to ten days, the monitoring will take place via telephone call daily until completion of the ten day treatment. you will be contacted again by telephone at 1, 3, and 6 months after completion of the study medication to inquire about your general health and any changes in health status. other medical information from your records and charts may also be collected by us for purposes of review for this study.

Eligibility criteria:
inclusion criteria: 1. in patients \>19 years of age 2. history of c. difficile diarrhea within 16 weeks and treated with flagyl or vancomycin during last episode. 3. patients started on antibiotics during current admission for any other indication at any point of time during hospital course. exclusion criteria: 1. current diagnosis of cdi 2. first episode of cdi during this admission. 3. allergy to vancomycin or other known intolerance 4. pregnant h) patient has received broad-spectrum antibiotics for more than 48 hours for this admission j) incarceration

Keywords: cdiff vancomycin infection clostridium difficile