Miracle-dz/UniFAR-FTUs huggingface dataset:
Saddle fit and management: An investigation of the association with equine thoracolumbar asymmetries, horse and rider health.

REASONS FOR PERFORMING STUDY No previous studies have investigated interrelationships between saddle fit/management, equine thoracolumbar asymmetries, rider and horse health. OBJECTIVES To assess associations between data obtained by clinical assessment and those provided by riders via a questionnaire. STUDY DESIGN Clinical assessment of a convenience sample of horses and riders compared with a Web-based questionnaire survey (n = 205). METHODS Horse thoracolumbar asymmetries at predetermined sites, the presence of lameness (in hand and/or ridden), saddle slip, saddle fit/management and rider straightness were assessed. Kappa statistics were used to assess the relationship between categorical clinical data and questionnaire data from riders. Spearman's correlation was used to investigate associations between outcomes from clinical assessment (horse, saddle and rider data) and information provided by riders. RESULTS There was a 40.5% (205 of 506) questionnaire response rate. Thirty horses (14.6%) had saddle slip, which was significantly associated with hindlimb lameness or gait abnormalities (P<0.001), but only 2 riders had considered a link between saddle slip and lameness. Rider back pain was common (38.5%) and associated with ill-fitting saddles (P = 0.03) and either a quadrupedally reduced cranial phase of the step or a stiff, stilted canter (P = 0.006). Well-fitted saddles were associated with frequent saddle fit checks (P = 0.004). Minor thoracolumbar asymmetries (P = 0.04) were negatively associated with ill-fitting saddles and positively associated with rider skill level (P = 0.001). CONCLUSIONS The interaction between the horse, saddle and rider is complex. Ill-fitting saddles and a stiff, stilted canter or quadrupedally reduced cranial phase of the step are associated with rider back pain. Equine back pain and minor thoracolumbar asymmetries are associated with ill-fitting saddles. Saddle fit should be checked more often than once yearly to lower the number of ill-fitting saddles. Riders, trainers and other professionals involved in equine care and performance need better education to recognise ill-fitting saddles, lameness, saddle slip and rider crookedness.
Impact of age on outcomes following continuous-flow left ventricular assist device implantation.

OBJECTIVES The goal of our study was to analyse the impact of age on outcomes in patients who underwent continuous-flow left ventricular assist device (CF-LVAD) placement at our institution. METHODS One hundred and twenty-eight patients were implanted with a CF-LVAD between January 2008 and June 2014. Eighty-five patients were implanted with the device as a bridge to transplant (BTT); the remaining (n = 43) were on destination therapy (DT). Each group was divided into patients <65 years old and ≥ 65 years old at device implantation. Patients were followed up for at least 24 months or until transplant or death. RESULTS Eighty-five patients (66%) received a CF-LVAD as BTT. Patients ≥ 65 years old (n = 8) had a lower preoperative cardiac index and prothrombin time-international normalized ratio (P = 0.009), and a longer stay in the intensive care unit (P = 0.008). Adverse events including infections, re-exploration for bleeding, ischaemic and haemorrhagic stroke, renal failure and right heart failure were comparable in both age groups. Eighty-two percent (n = 63) of the young patients and 75% (n = 6) of the older patients, who were on LVAD as BTT, underwent heart transplant within the first 24 months of LVAD implantation. Overall survival at 3, 6, 12 and 24 months were 95, 95, 77 and 70%, respectively, post-CF-LVAD implantation as BTT for the younger group and 73% for the older group at 3, 6 and 12 months (P = 0.35). Forty-three patients (34%) received a CF-LVAD as DT. Patients ≥ 65 years old (n = 14) on DT had a higher incidence of peripheral vascular disease (P = 0.048), higher serum sodium (P = 0.004) and serum creatinine values (P = 0.002), preoperatively. There were more strokes in the older patients post-LAVD implantation (14 vs 0%; P = 0.048). Overall survival at 3, 6, 12 and 24 months were 85, 79, 75 and 62%, respectively, for the younger group and 93, 77, 67 and 34% for the older group, respectively (P = 0.26). CONCLUSIONS This study demonstrates that LVAD therapy can be used in the older patients with acceptable mortality and morbidity, and age alone should not be used as the sole criterion for exclusion from LVAD implantation.
The Cure of Childhood Leukemia: Into the Age of Miracles

Half a decade ago, childhood leukaemia was always fatal. Though the number of new cases remains largely unchanged, what has changed is the outcome. Today, over 75 per cent of children with leukaemia can be cured. No-one can put a specific date on the cure of leukaemia or say which child was the first to live rather than die. Dr John Laszlo tells the story of this victory over cancer through the voices of nine doctors and researchers. In a counterpoint of voices from patients and parents, he recreates the tense world of hospital wards of desperately ill children, the bitter days when new therapies ended in relapses, and then the cautious hope as remissions became longer and longer.
Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis

Importance Coronary computed tomography angiography (CCTA) is a new approach for the diagnosis of anatomical coronary artery disease (CAD), but it is unclear how CCTA performs compared with the standard approach of functional stress testing. Objective To compare the clinical effectiveness of CCTA with that of functional stress testing for patients with suspected CAD. Data Sources A systematic literature search was conducted in PubMed and MEDLINE for English-language randomized clinical trials of CCTA published from January 1, 2000, to July 10, 2016. Study Selection Researchers selected randomized clinical trials that compared a primary strategy of CCTA with that of functional stress testing for patients with suspected CAD and reported data on patient clinical events and changes in therapy. Data Extraction and Synthesis Two reviewers independently extracted data from and assessed the quality of the trials. This analysis followed the PRISMA statement for reporting systematic reviews and meta-analyses and used the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. The Mantel-Haenszel method was used to conduct the primary analysis. Summary relative risks were calculated with a random-effects model. Main Outcomes and Measures The outcomes of interest were all-cause mortality, cardiac hospitalization, myocardial infarction, invasive coronary angiography, coronary revascularization, new CAD diagnoses, and change in prescription for aspirin and statins. Results Thirteen trials were included, with 10 315 patients in the CCTA arm and 9777 patients in the functional stress testing arm who were followed up for a mean duration of 18 months. There were no statistically significant differences between CCTA and functional stress testing in death (1.0% vs 1.1%; risk ratio [RR], 0.93; 95% CI, 0.71-1.21) or cardiac hospitalization (2.7% vs 2.7%; RR, 0.98; 95% CI, 0.79-1.21), but CCTA was associated with a reduction in the incidence of myocardial infarction (0.7% vs 1.1%; RR, 0.71; 95% CI, 0.53-0.96). Patients undergoing CCTA were significantly more likely to undergo invasive coronary angiography (11.7% vs 9.1%; RR, 1.33; 95% CI, 1.12-1.59) and revascularization (7.2% vs 4.5%; RR, 1.86; 95% CI, 1.43-2.43). They were also more likely to receive a diagnosis of new CAD and to have initiated aspirin or statin therapy. Conclusions and Relevance Compared with functional stress testing, CCTA is associated with a reduced incidence of myocardial infarction but an increased incidence of invasive coronary angiography, revascularization, CAD diagnoses, and new prescriptions for aspirin and statins. Despite these differences, CCTA is not associated with a reduction in mortality or cardiac hospitalizations.
Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: short- and mid-term outcomes.

OBJECTIVES It has been reported that the short-term mortality of concomitant aortic and mitral valve replacement (AVR and MVR) is considerable and concomitant coronary artery bypass graft (CABG) has adverse effects on the survival of patients with valve replacement surgery. We summarize the short- and mid-term outcome after concomitant CABG, AVR and MVR in our centre. METHODS Between 2003 and 2013, 103 patients (68 males, 35 females, age: 60.1 ± 10.1 years) underwent CABG, AVR and MVR for rheumatic heart disease (RHD) and coronary artery disease (CAD). The median follow-up was 47.6 months. Most of the patients were asymptomatic at rest. We analysed demographic, clinical and operative data of patients to define independent predictors of overall survival, cardiac event-free survival as well as cardiac death. RESULTS The rate of 30-day survival was 93% (n = 96). The corresponding rates of overall survival and cardiac event-free survival and the cumulative incidence rate of cardiac death at 1 year were 80.2, 77.3 and 10.9%; the same at 4 years were 73.7, 64.6 and 15.8%. The corresponding freedom rates from anticoagulation-associated major haemorrhage; a composite of major bleeding events, thromboemboli and valvular thrombosis; cardiac rehospitalization; major adverse valve-associated events; and significant malfunction of the prosthetic valve were 96.2, 95.3, 94.7, 81.6 and 97.7% at 1 year. The corresponding freedom rates from anticoagulation-associated major haemorrhage; a composite of major bleeding events, thromboemboli and valvular thrombosis; cardiac rehospitalization; major adverse valve-associated events; and significant malfunction of the prosthetic valve were 93.5, 91.0, 91.4, 73.5 and 95.5% at 4 years. The independent predictors of overall survival were age, cigarette smoking, chronic kidney diseases and balloon pump insertion. The independent predictors of cardiac event-free survival were age and previous myocardial infarction, while age, cigarette smoking, history of cerebrovascular accident and balloon pump insertion were the independent predictors of cardiac death. CONCLUSIONS Concomitant CABG, AVR and MVR for rheumatic heart disease accompanied by CAD appear to have acceptable short- and mid-term outcomes with symptomatic amelioration.
Lungeing on hard and soft surfaces: Movement symmetry of trotting horses considered sound by their owners.

REASONS FOR PERFORMING STUDY Lungeing is often part of the clinical lameness examination. The difference in movement symmetry, which is a commonly employed lameness measure, has not been quantified between surfaces. OBJECTIVES To compare head and pelvic movement symmetry between surfaces and reins during lungeing. STUDY DESIGN Quantitative gait analysis in 23 horses considered sound by their owners. METHODS Twenty-three horses were assessed in-hand and on the lunge on both reins on hard and soft surfaces with inertial sensors. Seven movement symmetry parameters were quantified and used to establish 2 groups, namely symmetrical (n = 9) and forelimb-lame horses (n = 14), based on values from straight-line assessment. Movement symmetry values for left rein measurements were side corrected to allow comparison of the amount of movement symmetry between reins. A mixed model (P<0.05) was used to study effects on movement symmetry of surface (hard/soft) and rein (inside/outside with respect to movement symmetry on the straight). RESULTS In forelimb-lame horses, surface and rein were identified as significantly affecting all head movement symmetry measures (rein, all P<0.0001; surface, all P<0.042). In the symmetrical group, no significant influence of surface or rein was identified for head movement symmetry (rein, all P>0.245; surface, all P>0.073). No significant influence of surface or rein was identified for any of the pelvic movement symmetry measures in either group. CONCLUSIONS While more symmetrical horses showed a consistent amount of movement symmetry across surfaces/reins, horses objectively quantified as lame on the straight showed decreased movement symmetry during lungeing, in particular with the lame limb on the inside of a hard circle. The variation within group questions straight-line movement symmetry as a sole measure of lameness without quantification of movement symmetry on the lunge, ideally on hard and soft surfaces to evaluate differences between reins and surfaces. In future, thresholds for lungeing need to be determined using simultaneous visual and objective assessment.
Bar shoes and ambient temperature are risk factors for exercise-induced pulmonary haemorrhage in Thoroughbred racehorses.

REASONS FOR PERFORMING STUDY Ambient temperature has been identified as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) in racing Thoroughbreds. This warranted a more expansive investigation of climatic conditions on the incidence and severity of EIPH. The impact of other variables such as the type of bit used, tongue ties and nonstandard shoes has not been reported and also warrant investigation. OBJECTIVES To examine the effect of various climatic variables as contributing risk factors for EIPH. Other previously uninvestigated variables as well as standard track and population factors will also be examined. STUDY DESIGN Cross-sectional study. METHODS Thoroughbred racehorses competing at metropolitan racetracks in Perth, Western Australia were examined 30-200 min post race with tracheobronchoscopy. Examination took place at 48 race meetings over a 12 month period. Examinations were graded (0-4), independently by two experienced veterinarians. Univariable analyses were performed and variables with a P<0.25 were entered into a multivariable logistic regression analysis. The analysis was performed twice using the presence of blood (EIPH grade 0 vs. grades ≥1) and EIPH grades ≤1 vs. EIPH grades ≥2 as dependent variables. RESULTS Exercise-induced pulmonary haemorrhage was diagnosed in 56.6% of observations. Lower ambient temperature was significantly associated with EIPH grades ≥1 (OR 0.95; 95% CI 0.93-0.98) and EIPH grades ≥2 (OR 0.97; 95% CI 0.94-1.0). Bar shoes were significantly associated with EIPH grades ≥1 (OR 6.35; 95% CI 2.17-18.54) and EIPH grades ≥2 (OR 2.72; 95% CI 1.3-5.68). Increasing race distance was significantly associated with EIPH grade ≥1 and increasing lifetime starts was significantly associated with EIPH grade ≥2. CONCLUSIONS Ambient temperature is a risk factor for EIPH in Thoroughbred racehorses, with lower temperatures associated with increased risk. Bar shoes are a novel risk factor for EIPH in this population.
Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies.

BACKGROUND Pulmonary metastasectomy via a traditional open thoracotomy is effective for the treatment of patients with pulmonary metastases. However, whether video-assisted thoracoscopic surgery (VATS) achieves similar clinical effects in terms of survival rates remains unclear. We conducted this meta-analytic study to compare VATS with open thoracotomy for pulmonary metastasectomy. METHODS Relevant studies were identified by searching PubMed from inception to December 2014. The overall and recurrence-free survival rates were measured in terms of hazard ratios (HRs) with VATS and open thoracotomy as the main outcomes. RESULTS Eight studies were included in our meta-analysis, which included 337 patients in the VATS group and 485 patients in the open thoracotomy group. The overall survival rate in the VATS group was statistically significantly higher than that in the open thoracotomy group [HR, 0.69; 95% confidence interval (CI), 0.55-0.87; P = 0.002]. The VATS group still had a higher overall survival rate after exclusion of the one low-quality study (HR, 0.78; 95% CI, 0.59-1.03), but the result was not statistically significant (P = 0.075). No difference in the recurrence-free survival rate was found between the two groups (HR, 0.86; 95% CI, 0.69-1.08). The subgroup analysis showed no difference between the two groups in either the overall survival rate (HR, 0.72; 95% CI, 0.50-1.04) or the recurrence-free survival rate (HR, 0.79; 95% CI, 0.59-1.08) in patients with metastases from colorectal cancer. CONCLUSIONS VATS is an alternative surgical approach for pulmonary metastasectomy in patients with resectable pulmonary metastases. Further large prospective studies are needed to identify the indications for VATS in patients with pulmonary metastases.
Ultrasonography of the equine abdomen: techniques and normal findings

ABDOMINAL ultrasonography is increasingly used in veterinary medicine and has an important role in decision-making in horses with colic. The technique has been used predominantly in foals and smaller horses, where rectal palpation is not possible, but is also a valuable diagnostic aid in the adult horse. It enables the veterinary surgeon to image regions of the abdomen that are inaccessible to rectal palpation, such as the duodenum and stomach. It allows abnormal rectal findings to be confirmed and, in many cases, provides further information. For example, rectal palpation may detect distended loops of small intestine, but ultrasonography will determine the degree of distension, any thickening of the intestinal wall, and the presence or absence of motility. Based on this, features that distinguish between surgical and non-surgical lesions can be identified. This, the first of two articles discussing the use of ultrasonography in the equine acute abdomen, describes the techniques of abdominal ultrasonography, and normal ultrasonographic findings. The second article, to be published in the next issue, will describe ultrasonographic changes occurring in the colic patient.
Retrospective analysis of factors associated with outcome of proximal interphalangeal joint arthrodesis in 82 horses including Warmblood and Thoroughbred sport horses and Quarter Horses (1992-2014).

REASONS FOR PERFORMING STUDY Outcomes associated with arthrodesis of the proximal interphalangeal (PIP) joint in Quarter Horses used for Western performance activities are well documented but little is known regarding outcomes for other types of horses. OBJECTIVES To identify factors associated with outcomes, including breed and activity, after arthrodesis of the PIP joint in Warmbloods, Thoroughbreds and Quarter Horses. STUDY DESIGN Retrospective case series. METHODS Surgical case records of 82 Quarter Horses principally engaged in Western performance and Thoroughbred or Warmblood breeds principally engaged in showing, showjumping and dressage, with arthrodesis of the PIP joint were reviewed. Arthrodesis was performed with either 3 transarticular cortex bone screws placed in lag fashion, a dynamic compression plate (DCP) with 2 transarticular cortex bone screws placed in lag fashion, or a locking compression plate (LCP) with 2 transarticular cortex bone screws placed in lag fashion. Demographic data, clinical presentation, radiographic findings, surgical technique, post operative treatment and complications were recorded. Long-term follow-up was obtained for all 82 horses. RESULTS Osteoarthritis of the PIP joint was the most common presenting condition requiring arthrodesis, which was performed with either the 3 screw technique (n = 41), DCP fixation (n = 22), or LCP fixation (n = 19). Post operatively, 23/31 (74%) Warmbloods/Thoroughbreds and 44/51 (87%) Quarter Horses achieved successful outcomes. Thirteen of 23 (57%) Warmbloods/Thoroughbreds and 24 of 38 (63%) Quarter Horses, used for athletic performance, returned to successful competition. Within this subgroup of horses engaged in high-level activity, regardless of breed type, horses undergoing hindlimb arthrodesis were significantly more likely to return to successful competition (73%; 33/45) than those with forelimb arthrodesis (25%; 4/16, P = 0.002). CONCLUSIONS Arthrodesis of the PIP joint in Warmbloods/Thoroughbreds and Quarter Horses results in a favourable outcome for return to their intended use and athletic competition.
Taking care of yourself: a grounded theory study about how young women make a decision about having a Papanicolau test

Newfoundland has one of the highest rates of cervical cancer in Canada and the western region of Newfoundland has the lowest cervical cancer screening rates. Young women, in particular, have a potential risk for cervical cancer. They initiate sexual intercourse at an early age, have an increased risk for sexually transmitted diseases and may not have the knowledge to access cervical cancer screening tests. The effectiveness of the Papanicolau test in reducing morbidity and mortality from cervical cancer is well accepted. The purpose of this study was to use a grounded theory approach to identify and describe the social processes that influence young women in western Newfoundland to make a decision about having a Papanicolau test. Interviews were conducted with 14 women, ages 19-29. Three main categories emerged from the data to show how these young women made decisions about having a Papanicolau test. Acquiring significant information was the first category. Using the information characterized the second category and the third category of 'changing perceptions' showed how young women's decision to incorporate having a Pap test into their regular health routine was reached. The central category that explained the relationship among all the categories was 'taking care of yourself'. -- The implications for nursing practice, nursing education and nursing research are included in the study findings.
Cytokines in Cancer Therapy

General principles of cytokine therapy in cancer interferons tumour necrosis factor and lymphotoxin interleukin 2 and lymphokine-activated killer cells the colony-stimulating factors the other interleukins transforming growth factor-B (Beta) and related molecules understanding and exploiting the cytokine network future directions in cytokine therapy.
Orthopaedic physiotherapy practitioners: Surgical and radiological referral rates

Purpose – The purpose of this paper is to discuss the scepticism that persists among medics regarding appropriateness of some aspects of services provided by extended scope physiotherapists (ESPs). This paper aims to highlight the extent and appropriateness of surgical and radiological referrals by ESPs working in an adult orthopaedic service.Design/methodology/approach – The patient pathway following ESP assessment was audited over 31 months. Parameters explored included ESP referral rates to orthopaedic consultants; the percentage of patients where the entire episode of care was managed by the ESP; whether orthopaedic referrals were appropriate in terms of surgical interventions; and numbers of radiology referrals specifically for knee or lumbar complaints.Findings – Of the patients, 79 per cent had their entire episode of care managed by ESPs. Of the patients, 9 per cent were referred on for a surgical opinion (of which 42 per cent knees, 20 per cent lumbar). 13 per cent were referred for x‐rays, 10 pe.