Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of Anxiety, Pain, and Hemodynamic Changes during Surgical Removal of Lower Third Molar under Local Anesthesia

Aim: The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure. Materials and Methods: Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant. Results: SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased. Conclusion: The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.
Apple polyphenols and cardiovascular disease - a review of the evidence.

Summary A diet high in fruits and vegetables has been associated with a lower risk of some diseases, including cardiovascular disease. Besides food constituents, such as fibre or beta-carotene, other bioactive plant compounds such as polyphenols have been suggested to contribute to this protective effect. Apples are one of the most popular fruits in the UK, and apples and apple products, such as fruit juices and apple purees, contribute to the total polyphenol intake of the UK population, although data on the extent of their contribution are not available. The aim of this review was to summarise the evidence available from human studies on the effect of polyphenols found in apples on cardiovascular risk factors, including blood lipids and blood pressure. The literature search comprised randomised clinical trials carried out in humans using either apples or apple products, or other foods or supplements containing a significant amount of one or more polyphenols present in apples. Our search showed that there is very limited evidence available from human studies. Preliminary findings show that polyphenols present in apples may potentially have a positive influence on blood lipid parameters and blood pressure in humans. However, firm conclusions cannot be made based on the limited studies available. Further research is needed to evaluate the full potential of polyphenols and their effect on human health.
Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Background: Patients who leave against medical advice (LAMA) is a universal problem. Neonates being unable to decide for their own, are dependent on parents for all decisions for their treatment. LAMA is a sensitive issue in neonatology practice with ethical and medico legal ramifications. This study was done to evaluate the factors associated with the decision of LAMA by care givers in our special newborn care unit (SNCU). Methods: This is a retrospective hospital based observational study and was conducted in SNCU of HNB Base Teaching Hospital, Srinagar, Garhwal. Data pertaining to LAMA between 1st August 2017 and 31st July 2018 was retrieved. Information obtained included place of birth, gestational age, weight, diagnoses, duration of hospital stay and reasons for LAMA. Data were entered into a Microsoft Excel Spread Sheet and analyzed using software. Graph Pad Prism v 7.04. Chi-Square test was used to test for significant difference among various groups.Results: Out of 689 neonates admitted in SNCU during the study period, 167 (24.24%) took LAMA. Male to female ratio of 1:1.1. 102 (61%) were inborn and 65 (39%) were out born. Term babies constituted 62.87%. 78.44% neonates were discharged within 7 days of admission. 58 (34.73%) neonates had sepsis and 30 (17.96%) had birth asphyxia. The commonest reason in 25.15% for taking LAMA was to take the neonate to better equipped facility followed by false perception that the baby is well enough to be discharged.Conclusions: Multiple factors contribute for getting a neonate discharged against medical advice. Improvement of infrastructure, training of health care staff for proper counselling, sensitivity and empathy towards neonate and the care givers can decrease the rate of LAMA.
Views of psycho-oncologists, physicians, and nurses on cancer care—A qualitative study

Background As worldwide cancer prevalence continues to increase, the challenges facing cancer care are also increasing. Various topics related to deficiencies in cancer care have been discussed repeatedly in the literature. The most frequently stated topics are the unmet psychosocial support needs of cancer patients, difficulties in multidisciplinary teamwork, difficulties in communication between physicians and patients, and issues in palliative care settings. However, there is little research regarding the views of health care providers on these topics. With the aim of gaining abundant information regarding the care of German cancer patients, this study explores the stances of psycho-oncologists, physicians, and nurses regarding the quality of cancer care. Materials and methods Semi-structured interviews were conducted at the University Medical Center Hamburg-Eppendorf (UKE) and in different oncological outpatient offices in Hamburg; twenty-five interviews in total were conducted with health care providers. Interviews were semi-structured to gain a broad range of information on cancer care. The data were analyzed using thematic analysis by Braun and Clarke with an inductive, constant comparison approach to identify themes and categorized codes. Results The following five principle themes were identified in the interviews: “psycho-oncological care”, “cooperation of health care providers”, “palliative care”, “health care provider-patient contact”, and “coordination and organization of care”. Participants seemed satisfied with the overall quality of cancer care in Germany. Nevertheless, the results showed deficiencies regarding communication among different health care providers and between health care providers and patients. Important findings in conjunction with these communication problems were a lack of psycho-oncological support, shortages in the oncology work force, language and cultural barriers, and deficient education in the communication of providers. Conclusions The statements of psycho-oncologists, physicians, and nurses on cancer care provide a suitable basis to conduct further focused research on the studied deficiencies in cancer care. In particular, communication in psycho-oncological care, communication within multidisciplinary teams, and health care provider-patient communication should be further explored with the aim of developing new ideas for improvements and thereby enhancing the quality of cancer care.
Pharmacokinetics of Once‐Daily Extended‐Release Tacrolimus Tablets Versus Twice‐Daily Capsules in De Novo Liver Transplant

The pharmacokinetics of once‐daily extended‐release tacrolimus tablets (LCPT) in de novo liver transplantation have not been previously reported. In this phase II, randomized, open‐label study, de novo liver transplant recipients were randomized to LCPT 0.07–0.13 mg/kg/day (taken once daily; n = 29) or twice‐daily immediate‐release tacrolimus capsules (IR‐Tac) at 0.10–0.15 mg/kg/day (divided twice daily; n = 29). Subsequent doses of both drugs were adjusted to maintain tacrolimus trough concentrations of 5 to 20 ng/mL through day 90, and 5–15 ng/mL thereafter. Twenty‐four‐hour pharmacokinetic profiles were obtained on days 1, 7, and 14, with trough concentration and efficacy/safety monitoring through year 1. Similar proportions of patients in both groups achieved therapeutic trough concentrations on days 7 and 14 (day 7: LCPT = 78%, IR‐Tac = 75%; day 14: LCPT = 86%, IR‐Tac = 91%) as well as similar systemic and peak exposure. There was a robust correlation between drug concentration at time 0 and area under the concentration‐time curve for both LCPT and IR‐Tac (respectively, day 7: r = 0.86 and 0.79; day 14: r = 0.93 and 0.86; P < .0001 for all). Dose adjustments during days 1 to 14 were frequent. Thirty‐five patients completed the extended‐use period. No significant differences in adverse events were seen between groups. Incidence of biopsy‐proven acute rejection (LCPT = 6 and IR‐Tac = 4) was similar on day 360. Between formulations, overall exposure was similar at 1 week after transplant with the characteristic delayed‐release pharmacokinetic profile of LCPT demonstrated in this novel population. These data support further investigation of the safety and efficacy of LCPT in de novo liver transplantation.
Early Life Factors and Longitudinal Blood Pressure Trajectories Are Associated With Elevated Blood Pressure in Early Adulthood: BT20 Cohort

Multiple perinatal and early life risk factors have been implicated in the development of hypertension. The BT20 (Birth to Twenty Plus) cohort in urban Soweto, South Africa, previously showed a prevalence of elevated blood pressure (EBP) that ranged from 22.4% at 5 years of age to 34.9% at 18 years of age. We sought to determine the prevalence of EBP at 23 years of age within this cohort and whether this could be linked to any maternal and early life factors and childhood and adolescent blood pressure trajectories. Blood pressure and anthropometric measurements were completed on cohort participants aged 23 years (n=1540; 49% men). Early life and maternal factors were obtained from previous data. Thirty-six percent of participants had EBP of whom 63% were men (P<0.001). The only association with maternal or early life factors was greater linear growth from birth to 2 years of age, which conferred a 19% increased risk (odds ratio, 1.19; 95% CI, 1.01–1.41). Women had a 77% lower risk of EBP (odds ratio, 0.23; 95% CI, 0.16–0.34) per SD. Participants within the highest systolic and diastolic blood pressure trajectories (where blood pressure was elevated early and remained elevated) were at significantly increased risk of EBP in early adulthood. For those in the highest systolic trajectory, this resulted in a 4-fold increased risk and for those in the highest diastolic trajectory, a 5-fold increased risk. These findings suggest that risk for EBP in adulthood may be set in childhood and adolescence.
Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum

In vitro fertilization involving frozen embryo transfer and donor oocytes increases preeclampsia risk. These in vitro fertilization protocols typically yield pregnancies without a corpus luteum (CL), which secretes vasoactive hormones. We investigated whether in vitro fertilization pregnancies without a CL disrupt maternal circulatory adaptations and increase preeclampsia risk. Women with 0 (n=26), 1 (n=23), or >1 (n=22) CL were serially evaluated before, during, and after pregnancy. Because increasing arterial compliance is a major physiological adaptation in pregnancy, we assessed carotid-femoral pulse wave velocity and transit time. In a parallel prospective cohort study, obstetric outcomes for singleton livebirths achieved with autologous oocytes were compared between groups by CL number (n=683). The expected decline in carotid-femoral pulse wave velocity and rise in carotid-femoral transit time during the first trimester were attenuated in the 0-CL compared with combined single/multiple-CL cohorts, which were similar (group-time interaction: P=0.06 and 0.03, respectively). The blunted changes of carotid-femoral pulse wave velocity and carotid-femoral transit time from prepregnancy in the 0-CL cohort were most striking at 10 to 12 weeks of gestation (P=0.01 and 0.006, respectively, versus 1 and >1 CL). Zero CL was predictive of preeclampsia (adjusted odds ratio, 2.73; 95% CI, 1.14–6.49) and preeclampsia with severe features (6.45; 95% CI, 1.94–25.09) compared with 1 CL. Programmed frozen embryo transfer cycles (0 CL) were associated with higher rates of preeclampsia (12.8% versus 3.9%; P=0.02) and preeclampsia with severe features (9.6% versus 0.8%; P=0.002) compared with modified natural frozen embryo transfer cycles (1 CL). In common in vitro fertilization protocols, absence of the CL perturbed the maternal circulation in early pregnancy and increased the incidence of preeclampsia.
Differences in Cancer-Specific Mortality of Right- Versus Left-Sided Colon Adenocarcinoma: A Surveillance, Epidemiology, and End Results Database Analysis.

PURPOSE Studies have shown an increased risk for all-cause mortality with right-sided colon cancer (RCC) as compared with left-sided colon cancer (LCC). However, these studies were unable to directly account for mortality events unrelated to cancer, known as other-cause mortality. We investigated the difference in cancer-specific mortality (CSM) between RCC and LCC at localized, regional, and metastatic stages, according to the Fine and Gray proportional hazards model, while accounting for other-cause mortality as a competing risk. METHODS Using the SEER database, we identified 90,635 patients with LCC (ie, involving the splenic flexure, descending, sigmoid, and rectosigmoid colon) and 112,679 patients with RCC (ie, involving the cecum, ascending, hepatic flexure, and transverse colon) diagnosed from 1998 to 2013. We performed a competing risk analysis for CSM using the Fine and Gray proportional hazard model, adjusting for age, sex, race, tumor grade, surgery status, year of diagnosis, and tumor laterality, with two-sided testing and a statistical significance threshold of 0.05. RESULTS Compared with LCC, RCC demonstrated statistically significant decreased CSM at the localized stage (adjusted hazards ratio [AHR], 0.865; P < .001), equivalent CSM at the regional stage (AHR, 0.990; P = .440), and increased CSM at the metastatic stage (AHR, 1.175; P < .001). CONCLUSION Using a competing risk model, we have shown that RCC, compared with LCC, is associated with lower CSM at the localized stage, equivalent CSM at the regional stage, and higher CSM at the metastatic stage. This pattern may correlate with variation in genetic factors, including known decreased prevalence of microsatellite instability in RCC with regional and metastatic disease.
Anterior segment optical coherence tomography and its clinical applications

Anterior segment optical coherence tomography (AS‐OCT) has become one of the cornerstones of non‐contact imaging modalities for assessing such structures as the cornea, anterior chamber angle, aqueous outflow pathway, sclera, and ocular surface structures. As such, it has a broad range of clinical applications, which have been independently reported in the literature. This paper aims to present a review of extant literature on the utility of AS‐OCT and its efficacy in clinical applications, and to evaluate the quality of available evidence. The following databases were searched from inception to 24 June 2018: Medline via Ovid, Cochrane Central Register of Controlled Trials, PubMed, World Health Organization International Clinical Trials Registry Platform, EMBASE, and CINAHL. Bibliographies of identified papers were hand searched. Inclusion criteria: articles describing or assessing the use of OCT for visualising the AS. The authors excluded studies without an identified primary outcome variable. One author independently selected studies, extracted data, and assessed for risk of bias using PRISMA guidelines. This review included 82 studies, of which there were 11 cohort studies, 37 case series, 10 case studies, 21 comparative observational studies, and three non‐systematic review articles. Primary outcome variables included anterior chamber angle, angle opening distance, angle recess area, trabecular iris angle, trabecula‐iris space area, corneal thickness, tear meniscus height, tear meniscus area, tear meniscus volume, and the morphology of AS structures, including the ocular surface, blebs, flaps, and graft sites. This review attempts to encompass the breadth and depth of evidence for AS‐OCT in the arena of diagnostics, therapeutics, and prognostics. At the same time, it brings to light the dearth of high‐level evidence on this topic, suggesting the important role of randomised controlled trials and meta‐analyses for the future validation of this technology.
Effects of high-intensity resistance circuit-based training in hypoxia on body composition and strength performance

Abstract Hypoxic training methods are increasingly being used by researchers in an attempt to improve performance in normoxic ambients. Moreover, previous research suggests that resistance training in hypoxia can cause physiological and muscle adaptations. The primary aim of this study was to compare the effects of 8 weeks of high-intensity resistance circuit-based (HRC) training in hypoxia on body composition and strength performance. The secondary aim was to examine the effects of HRC on metabolic parameters. Twenty-eight male participants were randomly assigned to either hypoxia (Fraction of inspired oxygen [FIO2] = 15%; HRChyp: n = 15; age: 24.6 ± 6.8 years; height: 177.4 ± 5.9 cm; weight: 74.9 ± 11.5 kg) or normoxia [FIO2] = 20.9%; HRCnorm: n = 13; age: 23.2 ± 5.2 years; height: 173.4 ± 6.2 cm; weight: 69.4 ± 7.4 kg) groups. Training sessions consisted of two blocks of three exercises (Block 1: bench press, leg extension and front pull down; Block 2: deadlift, elbow flexion and ankle extension). Each exercise was performed at six repetition maximum. Rest periods lasted for 35-s between exercises, 3-min between sets and 5-min between blocks. Participants exercised twice weekly for 8 weeks, and body composition, strength and blood tests were performed before and after the training program. Lean body mass and bone mineral density significantly increased over time in the HRChyp (p < .005; ES = 0.14 and p < .014; ES = 0.19, respectively) but not in the HRCnorm after training. Both groups improved their strength performance over time (p < .001), but without group effect differences. These results indicate that simulated hypoxia during HRC exercise produced trivial effects on lean body mass and bone mineral density compared to normoxia.
Brain network dynamics in schizophrenia: Reduced dynamism of the default mode network

Complex human behavior emerges from dynamic patterns of neural activity that transiently synchronize between distributed brain networks. This study aims to model the dynamics of neural activity in individuals with schizophrenia and to investigate whether the attributes of these dynamics associate with the disorder's behavioral and cognitive deficits. A hidden Markov model (HMM) was inferred from resting‐state functional magnetic resonance imaging (fMRI) data that was temporally concatenated across individuals with schizophrenia (n = 41) and healthy comparison individuals (n = 41). Under the HMM, fluctuations in fMRI activity within 14 canonical resting‐state networks were described using a repertoire of 12 brain states. The proportion of time spent in each state and the mean length of visits to each state were compared between groups, and canonical correlation analysis was used to test for associations between these state descriptors and symptom severity. Individuals with schizophrenia activated default mode and executive networks for a significantly shorter proportion of the 8‐min acquisition than healthy comparison individuals. While the default mode was activated less frequently in schizophrenia, the duration of each activation was on average 4–5 s longer than the comparison group. Severity of positive symptoms was associated with a longer proportion of time spent in states characterized by inactive default mode and executive networks, together with heightened activity in sensory networks. Furthermore, classifiers trained on the state descriptors predicted individual diagnostic status with an accuracy of 76–85%.
An update of molecular pathology of bone tumors. Lessons learned from investigating samples by next generation sequencing

The last decade has seen the majority of primary bone tumor subtypes become defined by molecular genetic alteration. Examples include giant cell tumour of bone (H3F3A p.G34W), chondroblastoma (H3F3B p.K36M), mesenchymal chondrosarcoma (HEY1‐NCOA2), chondromyxoid fibroma (GRM1 rearrangements), aneurysmal bone cyst (USP6 rearrangements), osteoblastoma/osteoid osteoma (FOS/FOSB rearrangements), and synovial chondromatosis (FN1‐ACVR2A and ACVR2A‐FN1). All such alterations are mutually exclusive. Many of these have been translated into clinical service using immunohistochemistry or FISH. 60% of central chondrosarcoma is characterised by either isocitrate dehydrogenase (IDH) 1 or IDH2 mutations distinguishing them from other cartilaginous tumours. In contrast, recurrent alterations which are clinically helpful have not been found in high grade osteosarcoma. High throughput next generation sequencing has also proved valuable in identifying germ line alterations in a significant proportion of young patients with primary malignant bone tumors. These findings will play an increasing role in reaching a diagnosis and in patient management.
The elephant in the record: On the multiplicity of data recording work

This article focuses on the production side of clinical data work, or data recording work, and in particular, on its multiplicity in terms of data variability. We report the findings from two case studies aimed at assessing the multiplicity that can be observed when the same medical phenomenon is recorded by multiple competent experts, yet the recorded data enable the knowledgeable management of illness trajectories. Often framed in terms of the latent unreliability of medical data, and then treated as a problem to solve, we argue that practitioners in the health informatics field must gain a greater awareness of the natural variability of data inscribing work, assess it, and design solutions that allow actors on both sides of clinical data work, that is, the production and care, as well as the primary and secondary uses of data to aptly inform each other’s practices.
Personalized prescription of imatinib in recurrent granulosa cell tumor of the ovary: case report

Ovarian cancer is the fifth leading cause of cancer-related female mortality and the most lethal gynecological cancer. In this report, we present a rare case of recurrent granulosa cell tumor (GCT) of the ovary. We describe the case of a 26-yr-old woman with progressive GCT of the right ovary despite multiple lines of therapy who underwent salvage therapy selection based on a novel bioinformatical decision support tool (Oncobox). This analysis generated a list of potentially actionable compounds, which when used clinically lead to partial response and later long-term stabilization of the patient's disease.