Miracle-dz/UniFAR-FTUs huggingface dataset:
Kidney function after off-pump or on-pump coronary artery bypass graft surgery: a randomized clinical trial.

IMPORTANCE Most acute kidney injury observed in the hospital is defined by sudden mild or moderate increases in the serum creatinine concentration, which may persist for several days. Such acute kidney injury is associated with lower long-term kidney function. However, it has not been demonstrated that an intervention that reduces the risk of such acute kidney injury better preserves long-term kidney function. OBJECTIVES To characterize the risk of acute kidney injury with an intervention in a randomized clinical trial and to determine if there is a difference between the 2 treatment groups in kidney function 1 year later. DESIGN, SETTING, AND PARTICIPANTS The Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularisation Study (CORONARY) enrolled 4752 patients undergoing first isolated coronary artery bypass graft (CABG) surgery at 79 sites in 19 countries. Patients were randomized to receive CABG surgery either with a beating-heart technique (off-pump) or with cardiopulmonary bypass (on-pump). From January 2010 to November 2011, 2932 patients (from 63 sites in 16 countries) from CORONARY were enrolled into a kidney function substudy to record serum creatinine concentrations during the postoperative period and at 1 year. The last 1-year serum creatinine concentration was recorded on January 18, 2013. MAIN OUTCOMES AND MEASURES Acute kidney injury within 30 days of surgery (≥50% increase in serum creatinine concentration from prerandomization concentration) and loss of kidney function at 1 year (≥20% loss in estimated glomerular filtration rate from prerandomization level). RESULTS Off-pump (n = 1472) vs on-pump (n = 1460) CABG surgery reduced the risk of acute kidney injury (17.5% vs 20.8%, respectively; relative risk, 0.83 [95% CI, 0.72-0.97], P = .01); however, there was no significant difference between the 2 groups in the loss of kidney function at 1 year (17.1% vs 15.3%, respectively; relative risk, 1.10 [95% CI, 0.95-1.29], P = .23). Results were consistent with multiple alternate continuous and categorical definitions of acute kidney injury or kidney function loss, and in the subgroup with baseline chronic kidney disease. CONCLUSIONS AND RELEVANCE Use of off-pump compared with on-pump CABG surgery reduced the risk of postoperative acute kidney injury, without evidence of better preserved kidney function with off-pump CABG surgery at 1 year. In this setting, an intervention that reduced the risk of mild to moderate acute kidney injury did not alter longer-term kidney function. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00463294.
Awareness of diabetic retinopathy amongst diabetic patients at the murtala mohammed hospital, Kano, Nigeria

Background: Blindness from diabetic retinopathy is a preventable complication of diabetes if the retinopathy is detected early. Among other approaches, strong awareness of retinopathy by diabetic patients could help in the early detection, management and prevention of this complication. This study sets out to determine the general awareness of diabetic retinopathy amongst diabetic patients attending the outpatient diabetes clinic of the Murtala Muhammad hospital, Kano. This is the central reference general hospital within the ancient and historic walls of the traditional city of Kano. The hospital has an eye unit but with a paucity of manpower and equipment. Most diabetic patients often on self-referral usually present to the eye clinic only when they experience a marked reduction in vision. In the case of diabetic retinopathy, this is unfortunately late for any meaningful intervention. Although primary diabetic caregivers are usually aware of the possibility of eye complications from diabetes, they tend to wait until patients make visual complaints before screening them or inviting eye care personnel to join in the management. Diabetic retinopathy screening protocols are in most cases either not available, or not strictly followed. Patient awareness of diabetic retinopathy and its associated risk factors should aid compliance with risk control measures, and help drive patient demand for retinopathy screening. Method: This is a cross sectional study conducted using an interviewer-administered questionnaire. All consenting adult patients seen at the diabetes clinic over a one-month period were recruited for the study. Results: A total of 185 patients were involved with a mean age of 55.4 years. The majority of the patients (78.4%) had no formal western education and were mainly traders, farmers or housewives. 84.3% of the patients were generally aware of diabetic retinopathy with their main source of information being hospital staff and fellow patients. 80.5% knew diabetic retinopathy could lead to blindness but only 15.7% have ever had retinopathy screening. There was little or no knowledge of retinopathy risk factors or the need for early detection through screening. Conclusion: Although there is general awareness of diabetic retinopathy amongst a majority of the patients, there is however little or no knowledge of its risk factors and prevention. There is therefore a need for increasing this awareness, and the provision of access to retinopathy screening services to the patients. Niger Med J. Vol. 50, No. 2, April – June, 2009: 38 – 41. Key words: Diabetic retinopathy, Awareness, Retinopathy screening, Nigeria
Sex-dependent alterations of Ca2+ cycling in human cardiac hypertrophy and heart failure.

AIMS Clinical studies have shown differences in the propensity for malignant ventricular arrhythmias between women and men suffering from cardiomyopathies and heart failure (HF). This is clinically relevant as it impacts therapies like prophylactic implantable cardioverter-defibrillator implantation but the pathomechanisms are unknown. As an increased sarcoplasmic reticulum (SR) Ca(2+) leak is arrhythmogenic, it could represent a cellular basis for this paradox. METHODS/RESULTS We evaluated the SR Ca(2+) leak with respect to sex differences in (i) afterload-induced cardiac hypertrophy (Hy) with preserved left ventricular (LV) function and (ii) end-stage HF. Cardiac function did not differ between sexes in both cardiac pathologies. Human cardiomyocytes isolated from female patients with Hy showed a significantly lower Ca(2+) spark frequency (CaSpF, confocal microscopy, Fluo3-AM) compared with men (P < 0.05). As Ca(2+) spark width and duration were similar in women and men, this difference in CaSpF did not yet translate into a significant difference of the calculated SR Ca(2+) leak between both sexes at this stage of disease (P = 0.14). Epifluorescence measurements (Fura2-AM) revealed comparable Ca(2+) cycling properties (diastolic Ca(2+) levels, amplitude of systolic Ca(2+) transients, SR Ca(2+) load) in patients of both sexes suffering from Hy. Additionally, the increased diastolic CaSpF in male patients with Hy did not yet translate into an elevated ratio of cells showing arrhythmic events (Ca(2+) waves, spontaneous Ca(2+) transients) (P = 0.77). In the transition to HF, both sexes showed an increase of the CaSpF (P < 0.05) and the sex dependence was even more pronounced. Female patients had a 69 ± 10% lower SR Ca(2+) leak (P < 0.05), which now even translated into a lower ratio of arrhythmic cells in female HF patients compared with men (P < 0.001). CONCLUSION These data show that the SR Ca(2+) leak is lower in women than in men with comparable cardiac impairment. Since the SR Ca(2+) leak triggers delayed afterdepolarizations, our findings may explain why women are less prone to ventricular arrhythmias and confirm the rationale of therapeutic measures reducing the SR Ca(2+) leak.
Prevalence and Risk Factors for Dyspareunia and Unsatisfying Sexual Relationships in a Cohort of Primiparous and Secondiparous Women After 12 Months Postpartum

ABSTRACT Dyspareunia is a common short-term pregnancy complication, rarely lasting longer than 1 year after delivery. Our study aims to determine postpartum dyspareunia prevalence and its impact on women's sexual health. In this retrospective study, we asked 602 women about dyspareunia and the quality of sexual intercourse through telephone interviews. The influence of dyspareunia on the quality of sexual intercourse and couple relationship is scored on a 4-point verbal scale according to its severity. Data were analyzed by R (version 2.8.0), considering significant p < . 05. Nearly 100% of women (99.9%) resumed their sexual activity; 16.2% of them reported dyspareunia significantly compromising their sexual intercourse and couple relationships. In univariate analysis, severe perineal tears are associated with persistent dyspareunia (p < .05). By multivariate analysis, postpartum dyspareunia results independently influenced by operative delivery, previous dyspareunia, recurrent urogenital infections and urge incontinence (p < .05), as well as by the Kristeller maneuver and partoanalgesia (p = .084) in the case of women who had a vaginal delivery. Dyspareunia significantly compromises women's sexual health postpartum, mostly caused by perineal trauma by means of delivery management and recurrent urogenital infections.
CARCINOGEN-INDUCED TUMORS OF THE THYMUS

A progressive decrease of the restoring effectivity of syngeneic or allogeneic thymus and functional thymoma grafts was observed when the treatment of neonatally thymectomized mice was delayed. Early treatment (5–20 days postthymectomy) was effective, while the number of restored animals was markedly decreased after late treatment (30–50 days postthymectomy). Similar results were obtained with subcutaneous or intraperitoneal thymus grafts and with thymus grafts within cell-impenetrable diffusion chambers. After the onset of the postthymectomy-wasting syndrome the only successful treatment was the implantation of multiple thymus grafts. On the other hand, single thymus grafts, thymoma grafts, or thymus or thymoma within diffusion chambers were ineffective. When spleen cells from 5-day old or 45-day old neonatally thymectomized animals were given in association with thymoma grafts, only the cells derived from the 5-day old thymectomized mice proved effective in restoring wasted thymectomized hosts. These results suggest that a population of cells sensitive to the action of the thymus decreases progressively with time in the absence of thymic function.
Pattern of admissions to the University of Port Harcourt Teaching Hospital intensive care unit - a 10-year analysis

Objective. To determine the admission pattern and outcome of patients in the Intensive Care Unit (ICU) of University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. Method. A retrospective review of all patients admitted to the ICU at the UPTH from 1996 to 2005 was carried out. Data were obtained from the ICU admission and discharge registers and nurses’ handover records. Results. A total of 1 447 patients were admitted from 15 departments. There were 658 males and 789 females (male/female ratio 1:1.2). Ages ranged from 4 months to 90 years, the median age was 30 years and the mean age was 31.7±5.6 years. The highest proportion of admissions (48.7%) was from the Department of Obstetrics and Gynaecology, and the lowest from Ophthalmology and Anaesthesia (0.1%). Postoperative cases made up 62.1% of total admissions, with post-caesarean section (CS) contributing 65.7% of these. Non-availability of beds in the ward was the reason for the majority of the post-CS admissions. Up to 41.5% of the patients admitted to the ICU had no justifiable reason for admission. Average length of stay was 8.1±2.8 days, median 4.5 days. One patient was manually ventilated for 5 hours, none was mechanically ventilated, and none had invasive cardiac monitoring. Three children had peritoneal dialysis for acute renal failure. Unconscious patients were fed enterally through a nasogastric tube, while conscious patients ate orally. Analysis of outcomes showed that 597 patients (41.3%) were transferred to the wards, while 352 (24.3%) were discharged home. The outcome was not indicated in 128 cases (8.8%), 16 patients (1.1%) left the ICU against medical advice, 1 patient (0.1%) was referred to another tertiary institution and 1 (0.1%) absconded. Three hundred and fifty-two patients died, giving a mortality rate of 24.3%. Conclusion. The highest percentage of admissions to the ICU was from the Department of Obstetrics and Gynaecology. The majority of the patients did not require intensive care but were admitted because there was no bed in the wards.
Update to Rociletinib Data with the RECIST Confirmed Response Rate.

To the Editor: In our Journal article that was published on April 30, 2015,1 we described the activity of rociletinib, an epidermal growth factor receptor (EGFR) inhibitor with specificity for the T790M mutation, in patients with EGFR mutation–positive lung cancer in the phase 1 TIGER-X trial. The key finding was a response rate of 59% (95% confidence interval [CI], 45 to 73) among 46 patients with biopsy-proven T790M-mediated resistance to previously administered EGFR inhibitors. In November 2015, Clovis Oncology issued a press release that contained updated data from a pooled cohort of patients from TIGER-X and TIGER-2 (another phase 2 .
HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel.

IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
Incidence of silent cerebral infarctions after catheter ablation of atrial fibrillation utilizing the second-generation cryoballoon

Aims Pulmonary vein (PV) isolation (PVI) utilizing a cryoballoon (CB) has become one of the standard therapeutic options for atrial fibrillation (AF). However, it connotes a potential risk of cerebral ischaemic events (CIEs). This study aimed to clarify the prevalence of CIEs after PVI using second-generation CBs assessed by magnetic resonance imaging (MRI) of the brain. Methods and results This prospective observational study consisted of 160 patients that underwent PVI with second-generation CBs for drug-refractory AF. Irrigated radiofrequency (RF) ablation for 'touch-up' procedures was utilized when conduction gaps between the left atrium (LA) and PVs were found after the CB application. Radiofrequency linear ablation was added in select patients. Cerebral MRI and neurological examinations were performed on the day following the ablation procedure. The MRI depicted micro-cerebral infarctions in 43 patients (26.9%, 1.49 lesions per case). All patients were free from symptomatic focal neurological deficits. Touch up ablation was required for the PVI establishment in 35 patients (21.9%). Linear ablation was performed in 59 patients (36.9%). Additional RF ablation within the LA was an independent risk of CIEs in the uni- and multivariate analyses. When the analyses were limited to patients who had undergone only CB ablation, CIEs were found in 12 of 66 patients (18.2%). Conclusion Pulmonary vein isolation utilizing second-generation CBs carries a negligible risk of symptomatic CIEs; however, it includes a comparable risk of asymptomatic CIEs as in the previous similar reports using the first-generation CB. Radiofrequency applications in addition to the CB within the LA were the only predictor of this adverse effect.
Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility

Aims Identification of left atrial (LA) fibrosis through late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) remains controversial due to the heterogeneity and lack of reproducibility of proposed methods. Our aim is to describe a normalized, reproducible, standardized method to evaluate LA fibrosis through LGE-CMR. Methods and results Electrocardiogram- and respiratory-gated 3-Tesla LGE-CMR was performed in 10 healthy young volunteers and 30 patients with atrial fibrillation (AF): 10 with paroxysmal AF, 10 with persistent AF, and 10 with a previous AF ablation procedure. Local image intensity ratio (IIR) of the LA was calculated as the absolute pixel intensity to mean blood pool intensity ratio. The healthy atrial tissue threshold was defined in young healthy volunteers (upper limit of normality set at IIR tissue mean plus 2 SDs). Dense atrial scarring was characterized in patients with previous radiofrequency-induced scarring (post-AF ablation patients). Validation groups consisted of patients with paroxysmal and persistent AFs. The upper limit of normal IIR was 1.20; IIR values higher than 1.32 (60% of mean maximum pixel intensity in post-ablation patients) were considered dense scar. Image intensity ratio values between 1.2 and 1.32 identified interstitial fibrosis. Patients with paroxysmal and persistent AFs had less atrial fibrotic tissue compared with post-ablation patients. Endocardial bipolar voltage was correlated to IIR values. Conclusions An IIR of 1.2 identifies the upper limit of normality in healthy young individuals. An IIR of >1.32 defines dense atrial fibrosis in post-ablation patients. Our results provide a consistent, comparable, and normalized tool to assess atrial arrhythmogenic substrate.
Bilaterale massive makronoduläre Nebennierenhyperplasie: Eine seltene Ursache des adrenalen Cushing-Syndroms

Bei einem 46jahrigen Patienten bestand seit 10 Jahren eine arterielle Hypertonie. In den letzten beiden Jahren entwickelten sich eine stammbetonte Adipositas sowie weitere typische Stigmata eines Cushing-Syndroms. Hormonanalysen ergaben einen Hypercortisolismus und ein supprimiertes Plasma-ACTH. Der Dexamethason-Hommtest erbrachte keine signifikante Suppression des Serum-Cortisols. Im CRH-Test und im Metopiron®-Test erwies sich das Plasma-ACTH als nicht stimulierbar. Im ACTH-Kurztest fand sich ein uberschiesender Cortisolanstieg. Die abdominelle Computertomographie zeigte beidseits stark vergroserte (6 × 4 cm), grosknotig veranderte Nebennieren. Eine adrenostatische Therapie mit Ketoconazol (400 mg/d) fuhrte zu Symptomen der adrenalen Insuffizienz, eine reduzierte Dosis von 200 mg/d senkte das Serum-Cortisol auf Werte zwischen 5 und 11 µg/dl und normalisierte den Blutdruck, und die klinischen Symptome des Cushing-Syndroms bildeten sich zuruck. Die anschliesende bilaterale Adrenalektomie bestatigte die Diagnose einer massiven makronodularen Nebennierenhyperplasie. Postoperativ wurde eine Substitutionstherapie mit zweimal 25 mg/d Cortisonacetat und 0,05 mg/d Fludrocortison eingeleitet.
The Education of Women in Ancient Rome

This chapter surveys the education of Roman women in Rome and Italy during the late Republic and the first three centuries of the Empire. The main topics are: women's opportunities to receive education, the kinds of education they received, the levels they could reach, and the judgments that were passed on educated women. The chapter's main focus is on the literary and philosophical education of women of wealthy urban families and on the mixed feelings their education aroused, but some attention is also paid to the varying levels of literacy and numeracy of women of the professional classes.
Aids in Africa: How the Poor are Dying

Figures, Tables and Boxes. Acronyms and Abbreviations. Acknowledgements. Introduction: Africa's AIDS Crisis in Context. 1. Stagnation, Decline and Vulnerability: A Brief History of Post-colonial Africa. 2. Understanding the Dynamics of HIV/AIDS in Africa. 3. The Social-Economic Impact of HIV/AIDS. 4. The Challenge of Scaling up HIV/AIDS Treatment Programmes in Africa. 5. Community-Based Strategies: Lessons from Below. 6. Setting Priorities for Confronting HIV/AIDS in Africa. Glossary. Notes. References. Index.
Issues in Quality Use of Medicines in two Non-English Speaking Background Communities

Compliance is a policy issue in the quality use of medicine that has attracted much interest; however, there is little research about medication compliance issues in people of non-English speaking backgrounds. This paper describes a qualitative data collection that was used to identify compliance issues, and possible approaches to these issues, in an area of South-Eastern Sydney with a high non-English speaking population. Two parallel, iterative, series of GP and consumer focus groups were held in Arabic and Chinese communities. Later focus groups built on the findings of earlier groups and sought to engage GPs and consumers in identifying issues in compliance, and possible approaches to these issues. The paper compares and contrasts the results from these two communities and suggests that the approach might be used to identify compliance issues in other communities. Communication around appropriate medication use was the key issue common to both communities. The Chinese community was otherwise much more critical of Western medicine than the Arahic community, perhaps because of the strength of traditional medicine in that culture.