Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis.

CONTEXT Osteoporosis and osteopenia are associated with increased fracture incidence. OBJECTIVE The aim of this study was to determine the comparative effectiveness of different pharmacological agents in reducing the risk of fragility fractures. DATA SOURCES We searched multiple databases through 12/9/2011. STUDY SELECTION Eligible studies were randomized controlled trials enrolling individuals at risk of developing fragility fractures and evaluating the efficacy of bisphosphonates, teriparatide, selective estrogen receptor modulators, denosumab, or calcium and vitamin D. DATA EXTRACTION Reviewers working independently and in duplicate determined study eligibility and collected descriptive, methodological quality, and outcome data. DATA SYNTHESIS This network meta-analysis included 116 trials (139,647 patients; median age, 64 yr; 86% females and 88% Caucasians; median follow-up, 24 months). Trials were at low to moderate risk of bias. Teriparatide had the highest risk reduction of fractures (odds ratios, 0.42, 0.30, and 0.50 for hip, vertebral, and nonvertebral fractures, respectively) and the highest probability of being ranked first for efficacy (probabilities of 42, 49, and 79% for hip, vertebral, and nonvertebral fractures, respectively). However, differences to denosumab, zoledronate, risedronate, ibandronate, and alendronate were not statistically significant. Raloxifene and bazedoxifene were likely less effective, although these data were limited. Calcium and vitamin D were ineffective given separately but reduced the risk of hip fractures if given in combination (odds ratio, 0.81; 95% confidence interval, 0.68–0.96). CONCLUSIONS Teriparatide, bisphosphonates, and denosumab are most effective in reducing the risk of fragility fractures. Differences in efficacy across drugs are small; therefore, patients and clinicians need to consider their associated harms and costs.
Comparative study in prolapse lumbar intervertebral disc (PLID) surgery by spinal vs general anaesthesia

Background Lumbar discectomy is most commonly performed under general anaesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anaesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under spinal anesthesia. Objective We have compared patient satisfaction between spinal versus general anaesthesia in patients for single level lumbar surgery. Methods Eighty consecutive patients of ASA grade I-II were recruited and randomized into two equal groups, with half of this patients receiving spinal anaesthesia (n-40) and the remainder general anaesthesia (n-40). A comprehensive postoperative evaluation was carried out documenting any anaesthetic complications, pace of physiological and functional recovery and patient satisfaction. Variables were recorded as pain level using a visual analogue scale (VAS) at 1, 6, 12 and 24 hours; patient level of satisfaction during the stay on the ward using verbal rating scale (VRS) as it was detected by A p-value < 0.05 were considered as significant. Results Spinal anaesthesia patients achieved the milestones of physiological and functional recovery more rapidly and reported less postoperative pain. Perioperative hypotension in 25 % of patients and none was hypertensive in spinal group and in G/A Group 05% of patients was hypotensive and 20% were hypertensive. Postoperative pain intensity more in G/A group than spinal group. Patient satisfaction in spinal group was more comparative to G/A group. Conclusion Spinal anaesthesia ensures better operating conditions, better postoperative pain control and a quicker postoperative recovery when compared to general anaesthesia for single level lumbar spine surgery DOI: http://dx.doi. org/10.3329/jbsa.v23i2. 18173 Journal of BSA, 2009; 23(2): 47-50
Bortezomib in the treatment of refractory thrombotic thrombocytopenic purpura

Acquired thrombotic thrombocytopenic purpura (TTP) is a rare, life‐threatening condition caused by autoantibody‐mediated inhibition of ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type‐1 motif, 13). Therapeutic plasma exchange (TPE) improves survival, but disease may be refractory despite therapy. Management and treatment response of refractory TTP is variable, with rituximab and other immunosuppression often being used. Case reports have suggested a benefit of the proteasome inhibitor, bortezomib, possibly due to elimination of the autoreactive plasma cells producing anti‐ADAMTS13 antibodies. We evaluated the effect of bortezomib in a series of primary refractory TTP patients unresponsive to intensive therapy. Bortezomib‐treated patients were identified from consecutive cases managed at two UK referral centres. Demographic and clinical data were extracted from hospital records. ADAMTS13 activity was measured using a fluorescence resonance energy transfer VWF73 assay, and anti‐ADAMTS13 IgG using enzyme‐linked immunosorbent asssay. We identified six bortezomib‐treated patients out of 51 consecutive cases of acute, acquired TTP. All patients received TPE, methylprednisolone and rituximab. Five of the six achieved complete remission with bortezomib, and one died of cardiac arrest due to underlying disease. No treatment‐related adverse events were observed. Mean follow‐up time after hospital discharge was 17 months (range: 3–33). Bortezomib appears effective in the treatment of a subgroup of cases with severe, refractory TTP. Prospective trials are required to further investigate this effect.
Disease characteristics and outcomes in younger adults with primary and secondary myelofibrosis

Myelofibrosis (MF) is a rare haematopoietic disorder, commonly diagnosed in the 6th decade: less than 20% are diagnosed before the age of 50 years. In this retrospective study we included all patients given a diagnosis of World Health Organization‐defined primary or secondary MF when aged ≤50 years. Forty‐three patients with a median age of 43 years were included. Median follow up was 44 months. Twenty‐two (51%) harboured the JAK2 V617F mutation, 18/43 (42%) CALR, 0/43 (0%) MPL mutations and 3/43 (7%) were ‘Triple Negative’ (TN). At the time of diagnosis, no significant differences existed in haematological and clinical phenotypes between JAK2, CALR and TN patients. The frequency of splenomegaly was greater (P = 0·047) in the JAK2‐mutated group compared to CALR‐mutated patients. In the whole cohort, the 5‐year probability of developing anaemia, thrombocytopenia and marked leucocytosis was 24%, 10% and 13% respectively. Finally, the cumulative incidence of thrombotic events and progression to acute myeloid leukaemia was 1% and 0·5% patient‐year respectively. No death was reported during the follow‐up. These findings suggest that MF in younger patients may have a more indolent course when compared to older patients.
Promoção da aquisição de produtos da agricultura familiar para a alimentação escolar em Territórios da Cidadania de Minas Gerais e Espírito Santo

OBJECTIVE: This study hopes to promote the acquisition of family farm products for school meals in Brazil's Territories of Citizenship. METHODS: This intervention study coordinated intersectoral networks face-to-face. The networks consisted of teams composed of a dietician, popular educator, and agronomist or agronomy technician. These teams visited all municipalities within the Citizenship Territories at least twice to coordinate the said networks, capable of promoting local mobilization processes, organization, and empowerment of different actors to acquire family farm products for school meals in the said municipalities. RESULTS: The most expressive results were: 14% of the municipalities improved the family farm organization; 14% of the managers began to support the food acquisition process according to Law no 11.947/2009; and 27% of the municipalities without a dietician hired one. The results were not considered satisfactory by the School Food Council. CONCLUSION: The actions were capable of promoting the implementation of the Federal Law Lei Federal no 11.947/2009 in the study Territories of Citizenship.
Long-term cognitive impairments and attentional deficits in patients with Cushing's disease and cortisol-producing adrenal adenoma in remission.

CONTEXT Cognitive function is impaired in patients with active Cushing's syndrome (CS). OBJECTIVE The aim was to study cognitive function in patients with CS in long-term remission. DESIGN We conducted a cross-sectional, case-controlled, single center study. PATIENTS Fifty-five patients previously treated for Cushing's disease (n = 43) and cortisol-producing adrenal adenoma (n = 12) and 55 controls matched for age, gender, and educational level participated in the study. METHODS Working memory, attention, information-processing speed, verbal fluency, and reading speed were studied using standardized neuropsychological testing and alerting, orienting, and executive control using the Attentional Network Test. Fatigue impact scale and the comprehensive psychopathological rating scale were used to evaluate fatigue and affective disorder. RESULTS Median (interquartile range) duration of remission was 13 (5-19) yr and the mean ± SD age at follow-up was 54 ± 14 yr. Compared to controls, patients had a higher score on the fatigue impact scale, indicating greater burdens of fatigue, and a higher score on the comprehensive psychopathological rating scale subscales for depression and anxiety. In a multivariate analysis, attention, spatial orienting, alerting, working memory, verbal fluency, and reading speed were all diminished in comparison to controls, independent of scores for affective disorder and fatigue. No overall difference in outcome was seen between patients in long-term remission for Cushing's disease and cortisol-producing adrenal adenoma. CONCLUSION Patients with CS in remission have impaired cognitive function that cannot be explained by the coexistence of affective disorder or chronic fatigue. The pattern of cognitive and attentional deficits suggests a more global involvement of the brain function than has previously been suggested.
Bendamustine can be a bridge to allogeneic transplantation in relapsed Hodgkin lymphoma refractory to brentuximab vedotin

Hodgkin lymphoma (HL) affects approximately 1500 new patients annually in the UK (Smith et al, 2011). Most patients are cured with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)-based treatment. Of those who relapse, about 60% achieve durable remission with salvage chemotherapy followed by consolidation high dose therapy (HDT) and autologous stem cell transplantation (ASCT). Treatment options at relapse after ASCT are limited and after second relapse, cure is infrequent. Brentuximab vedotin (BV) (Adcetris) is a CD30-directed antibody drug conjugate with an established role in treating relapsed/refractory HL (Gopal et al, 2012; Younes et al, 2012). In the UK, BV has been successfully used as a bridge to allogeneic stem cell transplantation (alloSCT) in approximately 25% of patients (Gibb et al, 2013). Nivolumab and other emerging PD-1 (PD1)/PD-L1 (CD274) checkpoint inhibitors are novel agents with very promising results in early phase clinical trials. In a phase l study of nivolumab involving 23 patients (including 78% post-ACST and 78% post-BV) the overall response rate (ORR) was 87% with 86% progression-free survival (PFS) at 24 weeks (Ansell et al, 2015).
Similar incidence of severe acute GVHD and less severe chronic GVHD in PBSCT from unmanipulated, haploidentical donors compared with that from matched sibling donors for patients with haematological malignancies

The features of graft‐versus‐host disease (GVHD) were compared between patients who underwent myeloablative conditioning and received a peripheral blood stem cell transplant (PBSCT) from either a haploidentical donor (HID) or a matched sibling donor (MSD) during the same period of time. The HID group included more patients with advanced disease. Both groups received the same GVHD prophylaxis with the addition of antithymoglobulin (ATG) in HID group. Higher cumulative incidences (CI) of acute GVHD grade 2–4 (35·1% vs. 13·9%, P = 0·003), similar CI of grade 3–4 (14·5% vs. 9·8%, P = 0·595), less 3‐year CI of extensive chronic GVHD (17·1% vs. 41·5%, P = 0·017) and less severe chronic GVHD (5·8% vs. 21·2%, P = 0·049) occurred in the HID group compared with the MSD group. There was no difference in the sites of the involved organs between these two groups. Higher 3‐year CI of non‐relapse mortality (24·0% vs. 10·2%, P = 0·014), relapse (39·0% vs. 22·6%, P = 0·032) and inferior disease‐free survival (45·7% vs. 78·9%, P = 0·000) were recorded in the HID cohort compared with the MSD group. More HID patients had Karnofsky scores above 90 than those in MSD group (P = 0·016). In conclusion, ATG plays a key role in the unmanipulated HID PBSCT protocol, producing better quality of life in survivors.
Characteristics of occupational therapy journals of WFOT member countries: a descriptive survey

There are many occupational therapy journals being published internationally, but little information is available about their characteristics. The purpose of this study was to gather relevant information about these journals. Examined are the journals' characteristics, the audiences they serve, the review process they use, the staff they employ, and the types of articles they publish. The study design was a descriptive survey format using an adapted version of the Survey of Editors Regarding Publishing Practices. Questionnaires were mailed to all the national occupational therapy associations that were members of the World Federation of Occupational Therapists (n=44) in September 1992. The response rate was 86.4% (n=38). The survey results indicated that a typical occupational therapy journal was published six times a year, with 84% of it being text and 15% of it being advertising. In terms of submission of manuscripts, the preferred average length was 14 pages using American Psychological Association format specifications. Respondents indicated that, on average, occupational therapy journals received 33 manuscripts a year for review, 20 of those being accepted for publication with minor revision, five needing major revision and eight being rejected. Most occupational therapy journals indicated that they were peer-reviewed/refereed publications. The most frequently cited reasons for rejecting manuscripts submitted for consideration for publication were: (1) content inaccurate; (2) content not important/significant; (3) poorly developed ideas; (4) methodology problems; (5) data interpretation problems; or (6) a poorly written manuscript. Most manuscripts published in occupational therapy journals have a clinical focus in the area of physical medicine or mental health. Results of the survey study are discussed and recommendations for future research are made. Copyright © 1997 Whurr Publishers Ltd.
Effect of tight glucose control with insulin on the thyroid axis of critically ill children and its relation with outcome.

CONTEXT Tight glucose control (TGC) to normal-for-age fasting blood glucose levels reduced morbidity and mortality in surgical adult and pediatric intensive care unit (ICU) patients. In adults, TGC did not affect the illness-induced alterations in thyroid hormones. With better feeding in children than in adult patients, we hypothesized that TGC in pediatric ICU patients reactivates the thyroid axis. OBJECTIVE The aim of this study was to assess the impact of TGC on the thyroid axis in pediatric ICU patients and to investigate how these changes affect the TGC outcome benefit. DESIGN AND PATIENTS We conducted a preplanned analysis of all patients not treated with thyroid hormone, dopamine, or corticosteroids who were included in a randomized controlled trial on TGC (n=700). MAIN OUTCOME MEASURES Serum TSH, T4, T3, and rT3 were measured upon admission and on ICU day 3 or the last ICU day for patients discharged earlier. Changes from baseline were compared for the TGC and usual care groups. The impact on the outcome benefit of TGC was assessed with multivariable Cox proportional hazard analysis, correcting for baseline risk factors. RESULTS TGC further lowered the T)/rT3 ratio (P=0.03), whereas TSH (P=0.09) and T4 (P=0.3) were unaltered. With TGC, the likelihood of earlier live discharge from the ICU was 19% higher at any time (hazard ratio, 1.190; 95% confidence interval, 1.010-1.407; P=0.03). This benefit was statistically explained by the further reduction of T3/rT3 with TGC because an increase in T3/rT3 was strongly associated with a lower likelihood for earlier live discharge (hazard ratio per unit increase, 0.863; 95% confidence interval, 0.806-0.927; P<0.0001). CONCLUSIONS TGC further accentuated the peripheral inactivation of thyroid hormone. This effect, mimicking a fasting response, statistically explained part of the clinical outcome benefit of TGC.
Guidelines for the use of platelet transfusions

NHSBT and Radcliffe Department of Medicine, University of Oxford, Oxford, NHSBT and Department of Haematology, North Bristol NHS Trust, Bristol, NHSBT and Department of Haematology, Royal London Hospital, London, Department of Haematology, Royal Cornwall Hospital Trust, Cornwall, Department of Critical Care Medicine & Anaesthesia, City Hospitals Sunderland NHS Foundation Trust, Sunderland, Department of Haematology, Royal Devon & Exeter NHS Foundation Trust, Exeter, School of Cellular and Molecular Medicine, University of Bristol, Bristol, NHSBT and Department of Haematology, John Radcliffe Hospital, Oxford and NHSBT, Newcastle upon Tyne, UK
GH replacement improves quality of life and metabolic parameters in cured acromegalic patients with growth hormone deficiency.

OBJECTIVE Effects of GH replacement in patients with GH deficiency (GHD) after a cure for acromegaly so far have been poorly studied, although its prevalence among acromegalic patients may reach the 60%. The aim of the study was to evaluate whether metabolic parameters and quality of life are improved by GH replacement in patients with prior acromegaly and severe GHD. DESIGN AND METHODS This was a prospective study on 42 GHD subjects [22 men, mean age (sd): 48 ± 10]: 10 acromegalics treated with recombinant human GH (group A), 12 acromegalics who refused treatment (group B), and 20 subjects operated for nonfunctioning pituitary adenoma on recombinant human GH (group C). Serum IGF-I levels, lipid profile, glucose levels (fasting and after an oral glucose tolerance test), glycosylated hemoglobin, insulin resistance (homeostasis model assessment insulin resistance index), anthropometric parameters (body mass index, waist circumference, body composition), and quality of life (Questions on Life Satisfaction-Hypopituitarism Z-scores) were evaluated at baseline and after 12 and 36 months. RESULTS At baseline, group B showed higher IGF sd score than group A and C, as well as better quality of life and higher post-oral glucose tolerance test glucose levels than group A. After 12-months, similarly in group A and C, the IGF-I sd score significantly increased, and body composition and lipid profile improved, without deterioration of glucose tolerance. Quality of life significantly improved too, and the baseline difference between group A and B disappeared. Results were confirmed after 36 months. CONCLUSIONS In GHD acromegalic patients, GH therapy improved body composition, lipid profile, and quality of life as in patients with GHD due to nonfunctioning pituitary adenoma, without negative effects on glucose metabolism. GH replacement therapy should be considered in these patients, as in patients with GHD from other causes.
RB but not R‐HCVAD is a feasible induction regimen prior to auto‐HCT in frontline MCL: results of SWOG Study S1106

Aggressive induction chemotherapy followed by autologous haematopoietic stem cell transplant (auto‐HCT) is effective for younger patients with mantle cell lymphoma (MCL). However, the optimal induction regimen is widely debated. The Southwestern Oncology Group S1106 trial was designed to assess rituximab plus hyperCVAD/MTX/ARAC (hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone, alternating with high dose cytarabine and methotrexate) (RH) versus rituximab plus bendamustine (RB) in a randomized phase II trial to select a pre‐transplant induction regimen for future development. Patients had previously untreated stage III, IV, or bulky stage II MCL and received either 4 cycles of RH or 6 cycles of RB, followed by auto‐HCT. Fifty‐three of a planned 160 patients were accrued; an unacceptably high mobilization failure rate (29%) on the RH arm prompted premature study closure. The estimated 2‐year progression‐free survival (PFS) was 81% vs. 82% and overall survival (OS) was 87% vs. 88% for RB and RH, respectively. RH is not an ideal platform for future multi‐centre transplant trials in MCL. RB achieved a 2‐year PFS of 81% and a 78% MRD negative rate. Premature closure of the study limited the sample size and the precision of PFS estimates and MRD rates. However, RB can achieve a deep remission and could be a platform for future trials in MCL.
How I manage patients with hairy cell leukaemia

Patients with hairy cell leukaemia (HCL) have highly favourable outcomes after purine analogue therapy. However, most patients subsequently relapse and require re‐treatment. A minority of patients develop purine analogue‐refractory disease. Targeted therapies have improved outcomes for such patients. Recently, the BRAF V600E mutation was identified in most patients with classical HCL, resulting in constitutive mitogen‐activated protein kinase pathway activation; impressive responses are achieved in heavily pre‐treated patients with BRAF inhibition. The CD22‐targeted immunoconjugate moxetumomab pasudotox and BTK inhibitor ibrutinib also achieve responses in relapsed and refractory patients. HCL variant and the IGHV4‐34 molecular variant of HCL lack BRAF mutation and have inferior outcomes with standard purine analogue therapy. The addition of rituximab to purine analogues achieves very high rates of minimal residual disease‐negative complete remission and improves outcomes for patients with HCL variant. Given the rarity of HCL, optimal integration of novel therapies into treatment algorithms will require well‐designed, collaborative studies.
Postura crânio-cervical em mulheres disfônicas

Purpose: To analyze the posture and the function of the craniocervical region in women with dysphonia. METHODS: Twenty eight women participated in the study (31.25±8.14 years), divided into two groups: experimental (N=16, patients with dyphonia) and control (N=12, clinically normal). The volunteers were submitted to evaluation of the Craniocervical Dysfunction Index (CDI) and photogrammetry, determining the anterior angle formed between the seventh cervical vertebra and the tragus, which corresponds to the head position in the sagittal plane. The analysis of the photos was carried out by three examiners, twice each, with an interval of one week between them. Data analysis used the Shapiro-Wilk test, followed by the Student's t-test, (p<0,05). RESULTS: No difference was found between the mean values of the anterior angle of the control (50.92±5.18 degrees) and the experimental (49.63±5.46 degrees) groups in the photogrammetry (p=0.2565). The CDI showed that the experimental group had craniocervical dysfunction, which was mild in 37.5% of the cases, moderate, in 37.5%, and severe in 25%. In the control group, 100% of the volunteers had presented mild craniocervical dysfunction. CONCLUSION: There was no difference between the evaluated groups regarding head position. However, dysphonic women presented more severe craniocervical dysfunction than the group control.