Miracle-dz/UniFAR-FTUs huggingface dataset:
Impact of the Prostate Imaging Reporting and Data System, Version 2, on MRI Diagnosis for Extracapsular Extension of Prostate Cancer.

OBJECTIVE The purpose of this study is to validate the Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), in assessing extracapsular extension (ECE), compared with PI-RADS, version 1 (PI-RADSv1). MATERIALS AND METHODS A total of 210 patients with clinically localized prostate cancer underwent MRI and radical prostatectomy. Two readers independently interpreted the MR images. In PI-RADSv1, 5-point ECE risk scoring was used. In PI-RADSv2, ECE criteria included morphologic features and a tumor-capsule contact length (CL) greater than 10 mm. The diagnostic performance of each PI-RADS version and the cutoff CL were evaluated. RESULTS ECE was found in 56 patients (26.7%). In PI-RADSv1, maximal accuracy was achieved with a risk score of 3 or greater. At this threshold, positive findings on PI-RADSv1 and PI-RADSv2 were identified in 21.0-34.3% and 49.0-51.4% of patients, respectively. Compared with PI-RADSv1, PI-RADSv2 had higher negative predictive values (84.9-89.1% vs 96.3-97.1%, respectively; p = 0.003 and 0.021, for each reader). PI-RADSv1 and PI-RADSv2 had positive predictive values of 56.9-70.5% and 49.1-50.5%, respectively (p = 0.025 and 0.300, respectively). Interobserver kappa values for PI-RADSv1 and PI-RADSv2 were 0.511 and 0.781, respectively. The best cutoff CL was greater than 10 mm among patients without morphologic features of ECE. For patients positive for ECE on the basis of PI-RADSv2 but not PI-RADSv1, 73.3-74.1% of prostate cancer cases with a biopsy Gleason score of 7 or less and 35.7-44.4% of cases with a biopsy Gleason score of 8 or higher were overstaged. CONCLUSION PI-RADSv2 reduces understaging and improves interobserver agreement in ECE assessment. However, overstaging is a concern, and the biopsy Gleason score may have a complementary role in reducing overstaging.
Treatments of horizontal root fractures: Four case reports

Horizontal root fractures are rare in comparison to other types of injuries and the reported prevalence in the literature is between 0.5% and 7%. The treatment and prognosis of root fractures depend on many variables, the most important being the length of time between trauma and treatment, degree of dislocation and mobility, site of fracture, fixation period, stage of root development, age of patient, and quality of treatment. The ideal healing type is hard tissue healing. The aim of these case reports is to present four different patients who had horizontal root fractures of immature permanent teeth treated by repositioning and fixation with good healing. Patients were referred to our clinic with a complaint of mobility and tenderness in their upper central incisors as a result of an orofacial injury. As a result of radiographical examination, horizontal fractures were diagnosed on the roots. Teeth were repositioned and rigid fixation was applied. Splints were retained for about 12 weeks. After splints were removed, patients were scheduled for follow-up visits at 3 month intervals. After long-term clinical and radiographical follow-up, all teeth presented positive response to electrical pulp tests, suggesting a repair of root fractures. These immature teeth showed radiographic evidence of continued root development and normal color and mobility, and no pain was observed in horizontal and vertical percussion tests. Patients reported no discomfort with their teeth. Using splints without any further treatment was found to be successful in the presence of suitable conditions for the treatment of horizontal root fractures.
Regional and gender variation in mortality amenable to health care services in Italy

Background: Mortality amenable to health care services (“amenable mortality”) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist”. Although it proved to be a reliable indicator of performance of health care services in the European countries at national level, evidence about its regional variation is limited. We analyzed the regional and gender variability in the performance of health care services using the amenable mortality rate and its contribution to all-cause mortality under age 75 for the period 2006–2009. Methods: The national amenable mortality rate was calculated as the average annual number of deaths for specific causes defined according to the list of Nolte and McKee over the average population aged 0–74 years per 100,000 inhabitants in Italy. The contribution of amenable mortality to all-cause mortality (%AM) was calculated as the ratio of amenable mortality rate to all-cause mortality rate. Results were then stratified by gender, region, and year. Data were drawn from national mortality statistics for the period 2006–2009 provided by the Italian Institute of Statistics (ISTAT). Results: During the index period, in Italy the age and sex-standardized death rate amenable to health care services (SDR) was 62.4 per 100,000 inhabitants: 65.8 per 100,000 for males and 59.0 for females. Amenable mortality accounted for about one-quarter (25.3%) of total mortality under age 75: one-fifth (20.1%) for males and one-third (32.9%) for females. Southern Italy generally had higher levels of amenable mortality, both in terms of SDR and %AM, except for Puglia. However, SDRs and %AM had a different geographical pattern, which was consistent for men and women. Examination of temporal trends revealed that SDR linearly declined between 2006 and 2009 (63.9 to 61.7 per 100,000; % change = –3.4%; p = 0.021), while %AM was almost stable (25.1% to 25.7%; % change = +2.4%; p = 0.120). Piedmont, Lombardy, the autonomous province of Trento, Veneto and Campania had a linear decrease in SDR, while Abruzzo had a linear increase in SDR. Puglia had a linear increase in %AM. Conclusions: The present study contributes additional evidence on the role of amenable mortality as a synthetic indicator of the effectiveness of health care services. We argue that, in a decentralized health care system such as the Italian one, regional stratification is needed to put amenable mortality into the context of the regional specificities of health care provision. We also demonstrated that it is important to consider both SDRs and %AM, because this latter measure can give an insight on the extent to which health services can contribute to ameliorating the health of a population. Thus, consideration of both SDRs and %AM can be useful for national and regional comparisons, and can constitute the basis for evidence-based policy decision making.
Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance).

OBJECTIVE The purpose of this study is to determine lymph node features on axillary ultrasound (US) images obtained after neoadjuvant chemotherapy that are associated with residual nodal disease in patients with initial biopsy-proven node-positive breast cancer. SUBJECTS AND METHODS All patients had axillary US performed after neoadjuvant chemotherapy. Axillary US images were centrally reviewed for lymph node size, cortical thickness, and cortical morphologic findings (type I indicated no visible cortex; type II, a hypoechoic cortex ≤ 3 mm; type III, a hypoechoic cortex > 3 mm; type IV, a generalized lobulated hypoechoic cortex; type V, focal hypoechoic cortical lobulation; and type VI, a totally hypoechoic node with no hilum). Lymph node characteristics were compared with final surgical pathologic findings. RESULTS Axillary US images obtained after neoadjuvant chemotherapy and surgical pathologic findings were available for 611 patients. Residual nodal disease was present in 373 patients (61.0%), and 238 (39.0%) had a complete nodal pathologic response. Increased cortical thickness (mean, 3.5 mm for node-positive disease vs 2.5 mm for node-negative disease) was associated with residual nodal disease. Lymph node short-axis and long-axis diameters were significantly associated with pathologic findings. Patients with nodal morphologic type I or II had the lowest rate of residual nodal disease (51 of 91 patients [56.0%] and 138 of 246 patients (56.1%), respectively), whereas those with nodal morphologic type VI had the highest rate (44 of 55 patients [80.0%]) (p = 0.004). The presence of fatty hilum was significantly associated with node-negative disease (p = 0.0013). CONCLUSION Axillary US performed after neoadjuvant chemotherapy is useful for nodal response assessment, with longer short-axis diameter, longer long-axis diameter, increased cortical thickness, and absence of fatty hilum significantly associated with residual nodal disease after neoadjuvant chemotherapy.
Does Access to Acute Medical Care Imply Access to Preventive Care?

While research shows that women with disabilities are more likely to have a regular source of care and to have a doctor visit than women without disabilities, anecdotal information indicates that women with disabilities have difficulties with access to preventive care such as Pap smears and mammograms. Using data from a nationally representative health utilization and expenditure survey, this paper examines access to preventive care for the population of disabled women in the United States. Descriptive results indicate that there may be significant differences in access to breast exams and Pap smears among women with and without disabilities. However, multivariate analysis shows that access to preventive care is most strongly influenced by structural variables such as income, education, and insurance rather than personal characteristics such as race, age, and disability. While increased access to acute care gives women with disabilities a modest advantage over women without disabilities in access to preventive care, this advantage is not strong enough to overcome structural disadvantages. Consumers' observations about physical access, transportation, and physician bias notwithstanding, policy solutions need to address structural inequities in education, employment, and access to adequate health insurance.
Correlates and outcomes of fatigue among incident dialysis patients.

BACKGROUND & OBJECTIVES Fatigue is a debilitating symptom experienced by patients undergoing dialysis, but there is only limited information on its prevalence and its association with patient outcomes. This study examines the correlates of self-reported fatigue at initiation of dialysis and after 1 yr and assesses the extent to which fatigue was associated with health-related quality of life and survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A longitudinal cohort of 917 incident hemodialysis and peritoneal dialysis patients who completed the CHOICE Health Experience Questionnaire (CHEQ) participated in the study. Fatigue was assessed using the SF-36 vitality scale. Known predictors of fatigue including sociodemographic and psychosocial factors, dialysis-related factors, biochemical variables including inflammatory markers, comorbidities, and medications were used as covariates. RESULTS A low vitality score was independently associated with white race, higher Index of Coexistent Disease score, higher body mass index, lack of physical exercise, antidepressant use, and higher C-reactive protein levels (CRP). A lower vitality score was strongly associated with lower SF-36 physical functioning, mental health, bodily pain scores, and decreased sleep quality (all P < 0.001) at baseline. Among surviving participants, higher serum creatinine at baseline was associated with preserved vitality at 1 yr. Patients with the highest baseline vitality scores were associated with longer survival (hazard ratio 0.75; 95% CI 0.58 to 0.96, P = 0.03). CONCLUSIONS The findings of this study demonstrate that ESRD patients experience profound levels of fatigue and elucidate its correlates. Also, the association of fatigue with survival may have significant implications for this population.
Renal phenotype in Lowe Syndrome: a selective proximal tubular dysfunction.

BACKGROUND AND OBJECTIVES Lowe syndrome is defined by congenital cataracts, mental retardation, and proximal tubulopathy and is due to mutations in OCRL. Recently, mutations in OCRL were found to underlie some patients with Dent disease, characterized by low molecular weight proteinuria, hypercalciuria, and nephrocalcinosis. This phenotypic heterogeneity is poorly understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The renal phenotype of 16 patients with Lowe syndrome (10.9 +/- 7.0 yr) under care of the authors was characterized to define overlap of symptoms with Dent disease and infer clues about OCRL function. Medical charts of patients were reviewed for data regarding glomerular filtration rate and markers of proximal tubular function. RESULTS All patients had low molecular weight proteinuria and albuminuria. Lysosomal enzymuria was elevated in all 11 patients assessed. Fifteen patients had hypercalciuria, and 14 aminoaciduria. Seven patients required bicarbonate and three required phosphate replacement; all others maintained normal serum values without supplementation. None of the patients had detectable glycosuria, and none had clinically overt rickets. GFR was mildly to moderately impaired and highly variable, with a trend of deterioration with age. CONCLUSIONS Patients with Lowe syndrome do not have renal Fanconi syndrome but a selective proximal tubulopathy, variable in extent and dominated by low molecular weight proteinuria and hypercalciuria, the classical features of Dent disease. These findings suggest that OCRL and ClC-5, the chloride channel mutated in Dent disease, are involved in similar reabsorption pathways in the proximal tubule.
Calciphylaxis from nonuremic causes: a systematic review.

BACKGROUND AND OBJECTIVES Calciphylaxis, or calcific uremic arteriolopathy, is a well-described entity in end-stage kidney disease and renal transplant patients; however, little systematic information is available on calciphylaxis from nonuremic causes. This systematic review was designed to characterize etiologies, clinical features, laboratory abnormalities, and prognosis of nonuremic calciphylaxis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review of literature for case reports and case series of nonuremic calciphylaxis was performed. Cases included met the operational definition of nonuremic calciphylaxis-histopathologic diagnosis of calciphylaxis in the absence of end-stage kidney disease, renal transplantation, or acute kidney injury requiring renal replacement therapy. RESULTS We found 36 cases (75% women, 63% Caucasian, aged 15 to 82 yr) of nonuremic calciphylaxis. Primary hyperparathyroidism, malignancy, alcoholic liver disease, and connective tissue disease were the most common reported causes. Preceding corticosteroid use was reported for 61% patients. Protein C and S deficiencies were seen in 11% of patients. Skin lesions were morphologically similar to calcific uremic arteriolopathy. Mortality rate was 52%, with sepsis being the leading cause of death. CONCLUSION Calciphylaxis should be considered while evaluating skin lesions in patients with predisposing conditions even in the absence of end-stage kidney disease and renal transplantation. Nonuremic calciphylaxis is reported most often in white women. Mineral abnormalities that are invoked as potential causes in calcific uremic arteriolopathy are often absent, suggesting that heterogeneous mechanisms may contribute to its pathogenesis. Nonuremic calciphylaxis is associated with high mortality, and there is no known effective treatment.
Cumulative patency of contemporary fistulas versus grafts (2000-2010).

BACKGROUND AND OBJECTIVES Comparisons of fistulas and grafts often overlook the high primary failure rate of fistulas. This study compared cumulative patency (time from access creation to permanent failure) of fistulas and grafts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Vascular accesses of 1140 hemodialysis patients from two centers (Toronto and London, Ontario, Canada, 2000-2010) were analyzed. Cumulative patency was compared between groups using Kaplan-Meier survival curves and log-rank tests. Hazard ratios (HRs) for fistula failure relative to grafts and 95% confidence intervals (95% CIs) are reported. RESULTS There were 1012 (88.8%) fistulas and 128 (11.2%) grafts. The primary failure rate was two times greater for fistulas than for grafts: 40% versus 19% (P<0.001). Cumulative patency did not differ between fistulas and grafts for the patients' first access (median, 7.4 versus 15.0 months, respectively [HR, 0.99; 95% CI, 0.79-1.23; P=0.85]) or for 600 with a subsequent access (7.0 versus 9.0 months [HR, 0.93; 95% CI, 0.77-1.13; P=0.39]). However, when primary failures were excluded, cumulative patency became significantly longer for fistulas than for grafts for both first and subsequent accesses (61.9 versus 23.8 months [HR, 0.56; 95% CI, 0.43-0.74; P<0.001] and 42.8 versus 15.9 months [HR, 0.56; 95% CI, 0.44-0.72; P<0.001]). Results were similar for forearm and upper-arm accesses. Compared with functioning fistulas, grafts necessitated twice as many angioplasties (1.4 versus 3.2/1000 days, respectively; P<0.001) and significantly more thrombolysis interventions (0.06 versus 0.98/1000 days; P<0.001) to maintain patency once matured and successfully used for dialysis. CONCLUSIONS Cumulative patency did not differ between fistulas and grafts; however, grafts necessitated more interventions to maintain functional patency.
Natriuretic peptides in chronic kidney disease.

BACKGROUND AND OBJECTIVES B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are biomarkers of cardiovascular disease that is common in patients with chronic kidney disease (CKD). Conflicting data on the influence of glomerular filtration rate (GFR) on BNP and NT-proBNP levels in CKD may stem from failure to account fully for the effects of coexistent cardiac disease, dysfunction, and volume overload. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Prospective head-to-head comparison of plasma BNP and NT-proBNP in ambulatory euvolemic CKD patients with normal LV ejection fraction and no manifest cardiac or vascular disease. GFR was estimated by the Modification of Diet in Renal Disease formula, BNP and NT-proBNP measured using Abbott AxSYM and Roche Elecsys assays, respectively, and cardiac morphology and function assessed by transthoracic echocardiography. RESULTS In 142 patients (42% female) of mean age 60 +/- 11 yr, mean left ventricular ejection fraction was 71% +/- 6%, GFR 38 +/- 14 ml/min per 1.73 m(2), and median BNP and NT-proBNP level 59 and 311 pg/ml, respectively. Multivariate predictors of NT-proBNP level were GFR, beta-blocker usage, LV mass index, and hemoglobin level. Plasma BNP was independently predicted by LV mass index and beta-blocker usage but not GFR. In the 74 patients without diastolic dysfunction, there was a significant rise in NT-proBNP but not BNP as GFR declined. CONCLUSIONS Unlike NT-proBNP, plasma BNP level is relatively independent of GFR. BNP may therefore be the more appropriate biomarker to screen for cardiac dysfunction in CKD.
Meeting KDOQI guideline goals at hemodialysis initiation and survival during the first year.

BACKGROUND AND OBJECTIVES To determine, in a national cohort of incident hemodialysis patients, whether meeting a greater number of National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guideline goals at dialysis initiation was independently associated, in a graded manner, with lower first-year mortality rates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients who initiated hemodialysis between June 1, 2005, and May 31, 2007, in the US were included in this retrospective cohort analysis. Guidelines examined were (1) use of arteriovenous fistula or graft at initiation; (2) hemoglobin > or = 11 g/dl; and (3) albumin at goal. The primary predictor variable was number of guideline goals (zero, one, two, or three) met at dialysis initiation. Cox regression analysis was used to compare time to death, adjusting for baseline characteristics. RESULTS At dialysis initiation, 59%, 31%, 9%, and 1.6% of patients met zero, one, two, or three guideline goals, respectively (total n = 192,307). After multivariate adjustment, mortality hazard ratios (95% confidence intervals) were 0.81 (0.80 to 0.83) for patients who met one, 0.53 (0.51 to 0.56) for patients who met two, and 0.34 (0.30 to 0.39) for patients who met three guideline goals, compared with patients who met none. Meeting each individual goal was also associated with lower mortality. CONCLUSIONS These findings suggest a graded association between meeting a greater number of evidence-based guideline goals at dialysis initiation and lower risk of death during the first year on dialysis.
Research in India: success through collaboration

Those contemplating research in developing countries should bear in mind the following: the collective wisdom of both foreign and local investigators should be pooled to determine the most appropriate research questions and ethical obligations. Several collaborative research programmes launched by the World Health Organization (WHO) have shown that it is eminently possible to engage in high-quality cross-cultural research, and many of these studies have generated a wealth ofdata from developing countries. Rigorous and highly sophisticated studies are possible in the developing world (Wilson, 1990). At the Schizophrenia Research Foundation (SCARF) we have had several opportunities to collaborate successfully with researchers both within and outside India (Eaton et ai, 1995; Thara & Eaton, 1996). This success has largely been due to mutual respect for one another's expertise and role with no room for patronisation and condescension.
The evolution and role of interferon gamma release assays (IGRAs) in moderate and low income settings.

The interferon gamma release assays have been extensively evaluated in the diagnosis of latent tuberculosis infection as well as in diagnosis of active pulmonary and extra-pulmonary tuberculosis since their introduction just over a decade ago. The results and recommendations published are confusing to say the least. The performance of these tests vary according to the population they are used in, including age, BCG vaccination status and immune status, the commercial test used, the TB burden of the country/ region and other factors intrinsic to the tests themselves. This review attempts to summarize the evolution of the IGRAs, particularly in the context of moderate and low income settings where a large question about their use still remains. Much work needs to be done before definitive recommendations about their role in the diagnostic algorithms of low and middle income countries can be made, but problems associated with the tests including cost and interpretation issues may limit the amount of work that can be invested productively in this evaluation. DOI: http://dx.doi. org/10.4038/sljid.v4i2. 7153 Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):56-66