Miracle-dz/UniFAR-FTUs huggingface dataset:
The Placebo Effect: An Interdisciplinary Exploration

Centuries of clinical experience show that placebos benefit a wide range of afflictions. And research over the past few decades has identified some of the mechanisms behind the placebo effect. But the health care community has yet to embrace and harness this important part of healing. The placebo response—more descriptively, response to the treatment situation—continues to be unwanted and disparaged. Why does the placebo response have such a dubious reputation? Why have we not embraced this important part of healing? The term "placebo" itself comes with unfortunate baggage. Latin for "I shall please," by the 14th century placebo had become a pejorative term meaning flatterer, sycophant, toady. When it entered medical terminology in the 19th century, the pejorative meaning stuck. Placebo was defined as a medicine given to please patients rather than to benefit them. Placebo continues to imply deception, fakery, and ineffectiveness. But one of the things most
Young adolescents’ engagement in dietary behaviour – the impact of gender, socio-economic status, self-efficacy and scientific literacy. Methodological aspects of constructing measures in nutrition literacy research using the Rasch model

Abstract Objective The present study validates a revised scale measuring individuals’ level of the ‘engagement in dietary behaviour’ aspect of ‘critical nutrition literacy’ and describes how background factors affect this aspect of Norwegian tenth-grade students’ nutrition literacy. Design Data were gathered electronically during a field trial of a standardised sample test in science. Test items and questionnaire constructs were distributed evenly across four electronic field-test booklets. Data management and analysis were performed using the RUMM2030 item analysis package and the IBM SPSS Statistics 20 statistical software package. Setting Students responded on computers at school. Subjects Seven hundred and forty tenth-grade students at twenty-seven randomly sampled public schools were enrolled in the field-test study. The engagement in dietary behaviour scale and the self-efficacy in science scale were distributed to 178 of these students. Results The dietary behaviour scale and the self-efficacy in science scale came out as valid, reliable and well-targeted instruments usable for the construction of measurements. Conclusions Girls and students with high self-efficacy reported higher engagement in dietary behaviour than other students. Socio-economic status and scientific literacy – measured as ability in science by applying an achievement test – did not correlate significantly different from zero with students’ engagement in dietary behaviour.
Forecasting the progress towards the target of Millennium Development Goal 1C in children under 5 years of age in Bangladesh

Abstract Objective To estimate the average annual rates of reduction of stunting, underweight and wasting for the period 1996 to 2011, and to evaluate whether Bangladesh will be expected to achieve the target of Millennium Development Goal 1C of reducing the prevalence of underweight by half by 2015. Design We used five nationwide, cross-sectional, Demographic and Health Survey data sets to estimate prevalence of undernutrition defined by stunting, underweight and wasting among children under 5 years of age using the WHO child growth standards. We then computed the average annual rates of reduction of prevalence of undernutrition using the formula derived by UNICEF. Finally, we projected the prevalence of undernutrition for the year 2015 using the estimated average annual rates of reduction. Setting Nationwide covering Bangladesh. Subjects Children under 5 years of age (n 28 941). Results The prevalence of stunting decreased by 18·8 % (from 60·0 % to 41·2 %), underweight by 16·0 % (from 52·2 % to 36·2 %) and wasting by 5·1 % (from 20·6 % to 15·5 %) during 1996 to 2011. The overall average annual rates of reduction were 2·84 %, 2·69 % and 2·47 %, respectively, for stunting, underweight and wasting. We forecast that in 2015, the prevalence of stunting, underweight and wasting will be 36·7 %, 32·5 % and 14·0 %, respectively, at the national level. The prevalence of undernutrition is likely to remain high in rural areas, in the Sylhet division and in the poorest wealth quintile. Conclusions Bangladesh is likely to achieve the Millennium Development Goal 1C target of reducing the prevalence of underweight by half by 2015. However, it is falling behind in reducing stunting and further investment is needed to reduce individual, household and environmental determinants of stunting in Bangladesh.
Interferon‐gamma gene polymorphism +874 A/T is associated with an increased risk of cytomegalovirus infection among Hispanic renal transplant recipients

Cytomegalovirus (CMV) is the most common cause of viral infection, causing morbidity and mortality among renal transplant recipients (RTRs). Cytokines such as tumor necrosis factor‐alpha (TNF‐α), interleukin‐10 (IL‐10), and interferon‐gamma (IFN‐γ) have been shown to possess antiviral properties, and their polymorphisms are associated with disease outcome. The aim was to investigate the association of gene polymorphisms in IL‐10, IFN‐γ, and TNF‐α with CMV infection in RTRs.
Students with Disabilities Use of Various Options to Access Alternative Schools and Area Learning Centers

Alternative schools that were developed to encourage students experiencing difficulties in conventional schools to graduate from high school have been in existence since the 1970s. Alternative schools represent a form of school choice available to parents and students. This investigation focused on the extent to which students with disabilities are accessing Alternative Schools and Area Learning Centers (ALC) in Minnesota. More specifically, attention centered on (a) the option used by both students with and without disabilities to enroll in the school, (b) the extent to which students crossed district boundaries to attend the school, and (c) differential participation by category of disability. Results indicate that students with disabilities are accessing Alternative SchooVALC programs in ways similar to non-disabled students. Moreover, students with emotionalhehavioral disorders are heavily represented in these schools. It also was discovered that when students enter these programs, special education l.
Cerebral toxoplasmosis in an adolescent post allogeneic hematopoietic stem cell transplantation: successful outcome by antiprotozoal chemotherapy and CD4+ T‐lymphocyte recovery

Toxoplasmosis is a rare opportunistic infection in pediatric allogeneic hematopoietic stem cell transplant (allo‐HSCT) recipients and associated with severe T‐cell deficiency. Here, we report the successful management of cerebral toxoplasmosis in a 15‐year‐old adolescent 4 months post allo‐HSCT for non‐Hodgkin lymphoma through rapid invasive diagnostics, long‐term antiprotozoal chemotherapy, and an hematopoietic stem cell boost for persistently poor graft function. While supportive care and antiprotozoal chemotherapy achieved stabilization, definite improvement only occurred following recovery of CD4+ T lymphocytes to >100 cells/μL. At 5 years after the diagnosis of toxoplasmosis, the patient is in continuing remission with normalized clinical and imaging findings.
Asthma control in pregnancy is associated with pre-conception dietary patterns

Abstract Objective To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy. Design Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern (Z-score), with values presented as odds ratio and 95 % confidence interval. Setting Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009–July 2013. Subjects One hundred and fifty-eight asthmatic pregnant women. Results Three dietary patterns were identified: (i) ‘high protein/fruit’ (strong food group loadings for fish, meat, chicken, fruit); (ii) ‘high fat/sugar/takeaway’ (takeaway foods, crisps, refined grains); and (iii) ‘vegetarian-type’ (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54; 95 % CI 1·07, 2·23; P=0·022). Women with uncontrolled asthma (n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma (n 43, all P≤0·05). Conclusions Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond.
Validation of the International Metastatic Renal-Cell Carcinoma Database Consortium (IMDC) prognostic model for first-line pazopanib in metastatic renal carcinoma: the Spanish Oncologic Genitourinary Group (SOGUG) SPAZO study.

BACKGROUND Patients with metastatic renal carcinoma (mRCC) treated with first-line pazopanib were not included in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model. SPAZO (NCT02282579) was a nation-wide retrospective observational study designed to assess the effectiveness and validate the IMDC prognostic model in patients treated with first-line pazopanib in clinical practice. PATIENTS AND METHODS Data of 278 patients, treated with first-line pazopanib for mRCC in 34 centres in Spain, were locally recorded and externally validated. Mean age was 66 years, there were 68.3% male, 93.5% clear-cell type, 74.8% nephrectomized, and 81.3% had ECOG 0-1. Metastatic sites were: lung 70.9%, lymph node 43.9%, bone 26.3%, soft tissue/skin 20.1%, liver 15.1%, CNS 7.2%, adrenal gland 6.5%, pleura/peritoneum 5.8%, pancreas 5%, and kidney 2.2%. After median follow-up of 23 months, 76.4% had discontinued pazopanib (57.2% due to progression), 47.9% had received second-line targeted therapy, and 48.9% had died. RESULTS According to IMDC prognostic model, 19.4% had favourable risk (FR), 57.2% intermediate risk (IR), and 23.4% poor risk (PR). No unexpected toxicities were recorded. Response rate was 30.3% (FR: 44%, IR: 30% PR: 17.3%). Median progression-free survival (whole population) was 11 months (32 in FR, 11 in IR, 4 in PR). Median and 2-year overall survival (whole population) were 22 months and 48.1%, respectively (FR: not reached and 81.6%, IR: 22 and 48.7%, PR: 7 and 18.8%). These estimations and their 95% confidence intervals are fully consistent with the outcomes predicted by the IMDC prognostic model. CONCLUSION Our results validate the IMDC model for first-line pazopanib in mRCC and confirm the effectiveness and safety of this treatment.
Prognostic value of tumor-infiltrating lymphocytes in Epstein-Barr virus-associated gastric cancer.

BACKGROUND This study explored the prognostic impact of tumor-infiltrating lymphocytes (TILs) and investigated whether three histologic subtypes (lymphoepithelioma-like carcinoma, carcinoma with Crohn's disease-like lymphoid reaction, and conventional-type adenocarcinoma) could stratify a prognostic subset for patients with Epstein-Barr virus (EBV)-associated gastric cancer (EBVaGC). MATERIALS AND METHODS After reviewing 1318 consecutive cases of surgically resected or endoscopic submucosal dissected gastric cancers, 120 patients were identified as EBV-positive using EBV-encoded RNA in situ hybridization. The evaluation of the percentage of intratumoral (iTu-) and stromal (str-) TILs was carried out, and the cases were also subclassified into three histologic subtypes as noted above. RESULTS Among the 120 patients, 73 patients (60.8%) and 60 patients (50.0%) were determined as str-TIL-positive and iTu-TIL-positive, respectively. In a univariate analysis, str-TIL-positivity was significantly associated with longer recurrence-free survival (RFS; P = 0.002) and disease-free survival (DFS; P = 0.008), yet not overall survival (OS; P = 0.145). While iTu-TIL-positivity has a tendency of favorable outcome indicator for DFS and OS, but statistically significant differences were not shown, respectively (RFS, P = 0.058; DFS, P = 0.151; OS, P = 0.191). In a multivariate analysis using a Cox proportional hazard model adjusted for age, pTNM stage, lymphatic invasion, perineural invasion, and venous invasion; histologic subtype, WHO classification, and str-TIL-positivity were independently or tentatively associated with favorable RFS (hazard ratio [HR] = 12.193, 95% confidence interval [95% CI] 1.039-143.055, P = 0.047) or DFS (HR = 4.836, 95% CI 0.917-25.525, P = 0.063). CONCLUSION The histologic subclassification and TILs can be used to predict RFS and DFS for patients with EBVaGC.
Clinical correlation of extensive-stage small-cell lung cancer genomics.

BACKGROUND Genomic studies in small-cell lung cancer (SCLC) lag far behind those carried out in nonsmall-cell lung cancer (NSCLC). To date, most SCLC studies have evaluated patients with surgically resectable disease. Here we sought to evaluate the genomic mutation spectrum of 'every-day' SCLC patient tumors with extensive stage disease (ES-SCLC) and to correlate mutations with the main clinical outcomes of response to chemotherapy, progression-free (PFS) and overall (OS) survival. PATIENTS AND METHODS A total of 50 SCLC patient tumors were examined in this study; targeted exome sequencing was obtained on 42 patients and whole-exome sequencing on 8 patients. Mutated genes were correlated with clinical outcomes using Kaplan-Meier methods (PFS, OS) and logistic regression (chemo-response). RB1 protein expression was detected by either western blotting of cultured cell lysates or immunohistochemistry of tumor specimens. RESULTS In all, 39 patients had ES-SCLC; 15 patients had either primary refractory/resistant disease and 21 patients had sensitive disease. The two most frequently mutated genes were TP53 (86%) and RB1 (58%); other frequently mutated genes (>10% patients) were involved in epigenetic regulation as well as the mTOR pathway. We identified a number of low-frequency, targetable mutations, including RICTOR, FGFR1, KIT, PTCH1 and RET. Using multivariate analysis, RB1 was the only significant factor (P = 0.038) in predicting response to first-line chemotherapy, with an odds ratio of 5.58 comparing mutant RB1 with wild-type. Patients with mutant RB1 had both better OS (11.7 versus 9.1 months P = 0.04) and PFS (11.2 versus 8.6 months, P = 0.06) compared with patients with wild-type RB1. Interestingly, ∼25% of SCLC cell lines and tumor specimens expressed RB1 protein, possibly representing the subgroup with wild-type RB1. CONCLUSIONS We found that SCLC tumors harboring no mutation in RB1 had a poor response to chemotherapy.
Selumetinib with and without erlotinib in KRAS mutant and KRAS wild-type advanced nonsmall-cell lung cancer.

BACKGROUND KRAS mutations in NSCLC are associated with a lack of response to epidermal growth factor receptor inhibitors. Selumetinib (AZD6244; ARRY-142886) is an oral selective MEK kinase inhibitor of the Ras/Raf/MEK/ERK pathway. PATIENTS AND METHODS Advanced nonsmall-cell lung cancer (NSCLC) patients failing one to two prior regimens underwent KRAS profiling. KRAS wild-type patients were randomized to erlotinib (150 mg daily) or a combination of selumetinib (150 mg daily) with erlotinib (100 mg daily). KRAS mutant patients were randomized to selumetinib (75 mg b.i.d.) or the combination. The primary end points were progression-free survival (PFS) for the KRAS wild-type cohort and objective response rate (ORR) for the KRAS mutant cohort. Biomarker studies of ERK phosphorylation and immune subsets were carried out. RESULTS From March 2010 to May 2013, 89 patients were screened; 41 KRAS mutant and 38 KRAS wild-type patients were enrolled. Median PFS in the KRAS wild-type arm was 2.4 months [95% confidence interval (CI) 1.3-3.7] for erlotinib alone and 2.1 months (95% CI 1.8-5.1) for the combination. The ORR in the KRAS mutant group was 0% (95% CI 0.0% to 33.6%) for selumetinib alone and 10% (95% CI 2.1% to 26.3%) for the combination. Combination therapy resulted in increased toxicities, requiring dose reductions (56%) and discontinuation (8%). Programmed cell death-1 expression on regulatory T cells (Tregs), Tim-3 on CD8+ T cells and Th17 levels were associated with PFS and overall survival in patients receiving selumetinib. CONCLUSIONS This study failed to show improvement in ORR or PFS with combination therapy of selumetinib and erlotinib over monotherapy in KRAS mutant and KRAS wild-type advanced NSCLC. The association of immune subsets and immune checkpoint receptor expression with selumetinib may warrant further studies.
Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab.

BACKGROUND Clinical responses to ipilimumab are variable in terms of onset, magnitude and duration. Upfront identification of patients who are more likely or unlikely to benefit from treatment is a major need. PATIENTS AND METHODS Prospectively collected data from 720 advanced melanoma patients treated with ipilimumab 3 mg/kg within the Italian expanded access program were analyzed. The derived neutrophil-to-lymphocyte ratio (dNLR) was calculated from baseline peripheral blood cell counts, and receiver operating characteristic curve was used to evaluate the best cutoff for this marker. Patients were stratified according to dichotomized baseline absolute neutrophil counts (ANC), dNLR and their combination. The prognostic values of ANC and dNLR for survival were assessed using multivariate Cox proportional hazard models. A subgroup analysis including LDH in the models was also carried out. RESULTS The median follow-up was 16.5 months. The optimal cutoff for dNLR was 3. Baseline ANC and dNLR were significantly associated with the outcome of ipilimumab-treated melanoma patients, in terms of disease progression and death (P < 0.0001 for all). Furthermore, for each elevated variable, prognosis worsened. Patients with both ANC ≥ 7500 and dNLR ≥ 3 had a significantly and independently increased risk of death [hazard ratio(HR) = 5.76; 95% confidence interval (CI) 4.29-7.75] and of progression (HR = 4.10; 95% CI 3.08-5.46) compared with patients with both lower ANC and dNLR. Patients with one of the two factors elevated displayed an intermediate risk of progression and death. The 1- and 2-year survival rates were 2% and 0%, respectively, for patients with ANC ≥ 7500 and dNLR ≥ 3, and 43% and 24%, respectively, for patients with both lower ANC and dNLR. CONCLUSIONS Although these findings need to be confirmed and validated, we suggest that a neutrophil-based index may help risk-group stratification and assist disease-management strategies. Furthermore, the potential predictive value of this index for response to ipilimumab should be investigated in randomized clinical trials.
A phase I trial of panobinostat and epirubicin in solid tumors with a dose expansion in patients with sarcoma.

BACKGROUND Treatment options for sarcoma are limited. Histone deacetylase inhibitors increase the efficacy of topoisomerase II inhibitors by promoting access to chromatin and by down-regulating DNA repair. Thus, combined panobinostat and epirubicin therapy was evaluated to treat refractory sarcoma. PATIENTS AND METHODS Patients with advanced solid tumors were enrolled in a 3 + 3 dose-escalation phase I trial of panobinostat given on days 1, 3, and 5 followed by 75 mg/m(2) of epirubicin on day 5 in 21-day cycles, with a dose expansion at maximum tolerated dose (MTD) in 20 sarcoma patients. Peripheral blood mononucleocyte histone acetylation was also evaluated. RESULTS Forty patients received 20-60 mg panobinostat. Dose-limiting toxicities included thrombocytopenia, febrile neutropenia, and fatigue at 60 mg, defining a panobinostat MTD at 50 mg. Four responses were seen in 37 assessable patients, all after progression on prior topoisomerase II inhibitors. For those with sarcoma, 12 of 20 derived clinical benefit (1 partial response and 11 stable disease, median overall survival 8.3 months), including 8 of 14 previously progressed on topoisomerase II therapy. Treatment benefits correlated with increased histone acetylation and decreased neutrophil count on day 5. CONCLUSIONS Panobinostat and epirubicin treatment is well tolerated and may reverse anthracycline resistance. Changes in histone acetylation and associated decrease in neutrophil count correlated with clinical benefit and warrant investigation as predictive biomarkers. CLINICAL TRIAL This trial is registered at www.Clinicaltrials. gov, Identifier: NCT00878904.
Sociodemographic characteristics determine dietary pattern adherence during pregnancy

Abstract Objective Sociodemographic factors may affect adherence to specific dietary patterns during pregnancy. The present study aimed to identify dietary patterns during pregnancy and associated factors among Brazilian pregnant women. Design A cross-sectional analysis. Dietary intake was evaluated with a semi-quantitative FFQ during the first postpartum week; the time frame included the second and third gestational trimesters. Principal component analysis was used to identify dietary patterns during pregnancy. Sociodemographic data were obtained using a structured questionnaire. Multiple linear regressions were applied to test the associations between the sociodemographic factors and dietary patterns. Setting Mesquita, Rio de Janeiro, Brazil, 2011. Subjects Postpartum women (n 327) who were 18–45 years of age and Mesquita residents. Results Three different dietary patterns were identified: ‘healthy’ (mainly comprising legumes, vegetables and fruits), ‘mixed’ (mainly comprising candy, butter and margarine, and snacks) and ‘traditional’ (mainly comprising beans and rice). Women with a higher monthly per capita family income (β=0·0006; 95 % CI 0·0001, 0·001; P=0·011) and women of older age (β=0·021; 95 % CI −0·001, 0·042; P=0·058) were more likely to adhere to the ‘healthy’ dietary pattern. Women with higher parity were less likely to adhere to the ‘healthy’ pattern (β=−0·097; 95 % CI −0·184, −0·009; P=0·030) and were more likely to adhere to the ‘traditional’ pattern (β=0·098; 95 % CI 0·021, 0·175; P=0·012). Although not statistically significant, older women were less likely to adhere to the ‘mixed’ (β=−0·017; 95 % CI −0·037, 0·003; P=0·075) and ‘traditional’ (β=−0·018; 95 % CI −0·037, 0·001; P=0·061) dietary patterns. Conclusions Monthly per capita family income, parity and maternal age were factors associated with adherence to a healthy diet during pregnancy.