Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial

Importance Transcatheter aortic valve replacement (TAVR) is established for selected patients with severe aortic stenosis. However, limitations such as suboptimal deployment, conduction disturbances, and paravalvular leak occur. Objective To evaluate if a mechanically expanded valve (MEV) is noninferior to an approved self-expanding valve (SEV) in high-risk patients with aortic stenosis undergoing TAVR. Design, Setting, and Participants The REPRISE III trial was conducted in 912 patients with high or extreme risk and severe, symptomatic aortic stenosis at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015, with final follow-up on March 8, 2017. Interventions Participants were randomized in a 2:1 ratio to receive either an MEV (n = 607) or an SEV (n = 305). Main Outcomes and Measures The primary safety end point was the 30-day composite of all-cause mortality, stroke, life-threatening or major bleeding, stage 2/3 acute kidney injury, and major vascular complications tested for noninferiority (margin, 10.5%). The primary effectiveness end point was the 1-year composite of all-cause mortality, disabling stroke, and moderate or greater paravalvular leak tested for noninferiority (margin, 9.5%). If noninferiority criteria were met, the secondary end point of 1-year moderate or greater paravalvular leak was tested for superiority in the full analysis data set. Results Among 912 randomized patients (mean age, 82.8 [SD, 7.3] years; 463 [51%] women; predicted risk of mortality, 6.8%), 874 (96%) were evaluable at 1 year. The primary safety composite end point at 30 days occurred in 20.3% of MEV patients and 17.2% of SEV patients (difference, 3.1%; Farrington-Manning 97.5% CI, −∞ to 8.3%; P = .003 for noninferiority). At 1 year, the primary effectiveness composite end point occurred in 15.4% with the MEV and 25.5% with the SEV (difference, −10.1%; Farrington-Manning 97.5% CI, −∞ to −4.4%; P<.001 for noninferiority). The 1-year rates of moderate or severe paravalvular leak were 0.9% for the MEV and 6.8% for the SEV (difference, −6.1%; 95% CI, −9.6% to −2.6%; P < .001). The superiority analysis for primary effectiveness was statistically significant (difference, −10.2%; 95% CI, −16.3% to −4.0%; P < .001). The MEV had higher rates of new pacemaker implants (35.5% vs 19.6%; P < .001) and valve thrombosis (1.5% vs 0%) but lower rates of repeat procedures (0.2% vs 2.0%), valve-in-valve deployments (0% vs 3.7%), and valve malpositioning (0% vs 2.7%). Conclusions and Relevance Among high-risk patients with aortic stenosis, use of the MEV compared with the SEV did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. These findings suggest that the MEV may be a useful addition for TAVR in high-risk patients. Trial Registration ClinicalTrials.gov Identifier: NCT02202434
Aortic Valve Stenosis Planimetry by Means of Three‐Dimensional Transesophageal Echocardiography in the Real Clinical Setting: Feasibility, Reliability and Systematic Deviations

To assess the feasibility and reliability of aortic valve area (AVA) planimetry by means of three‐dimensional transesophageal echocardiography (3DTEE) as compared with the transthoracic echocardiogram (TTE) calculation of AVA, to determine the systematic deviations between measurements, and to describe the distribution of mean systolic in relation with 3DTEE anatomical AVA.
Functional outcome after language mapping for glioma resection.

BACKGROUND Language sites in the cortex of the brain vary among patients. Language mapping while the patient is awake is an intraoperative technique designed to minimize language deficits associated with brain-tumor resection. METHODS To study language function after brain-tumor resection with language mapping, we examined 250 consecutive patients with gliomas. Positive language sites (i.e., language regions in the cortex of the brain, 1 cm by 1 cm, which were temporarily inactivated by means of a bipolar electrode) were identified and categorized into cortical language maps. The tumors were resected up to 1 cm from the cortical areas where intraoperative stimulation produced a disturbance in language. Our resection strategy did not require identification of the stimulation-induced language sites within the field of exposure. RESULTS A total of 145 of the 250 patients (58.0%) had at least one site with an intraoperative stimulation-induced speech arrest, 82 patients had anomia, and 23 patients had alexia. Overall, 3094 of 3281 cortical sites (94.3%) were not associated with stimulation-induced language deficits. A total of 159 patients (63.6%) had intact speech preoperatively. One week after surgery, baseline language function remained in 194 patients (77.6%), it worsened in 21 patients (8.4%), and 35 patients (14.0%) had new speech deficits. However, 6 months after surgery, only 4 of 243 surviving patients (1.6%) had a persistent language deficit. Cortical maps generated with intraoperative language data also showed surprising variability in language localization within the dominant hemisphere. CONCLUSIONS Craniotomies tailored to limit cortical exposure, even without localization of positive language sites, permit most gliomas to be aggressively resected without language deficits. The composite language maps generated in our study suggest that our current models of human language organization insufficiently account for observed language function.
A comparison of bare-metal and drug-eluting stents for off-label indications.

BACKGROUND Recent reports suggest that off-label use of drug-eluting stents is associated with an increased incidence of adverse events. Whether the use of bare-metal stents would yield different results is unknown. METHODS We analyzed data from 6551 patients in the National Heart, Lung, and Blood Institute Dynamic Registry according to whether they were treated with drug-eluting stents or bare-metal stents and whether use was standard or off-label. Patients were followed for 1 year for the occurrence of cardiovascular events and death. Off-label use was defined as use in restenotic lesions, lesions in a bypass graft, left main coronary artery disease, or ostial, bifurcated, or totally occluded lesions, as well as use in patients with a reference-vessel diameter of less than 2.5 mm or greater than 3.75 mm or a lesion length of more than 30 mm. RESULTS Off-label use occurred in 54.7% of all patients with bare-metal stents and 48.7% of patients with drug-eluting stents. As compared with patients with bare-metal stents, patients with drug-eluting stents had a higher prevalence of diabetes, hypertension, renal disease, previous percutaneous coronary intervention and coronary-artery bypass grafting, and multivessel coronary artery disease. One year after intervention, however, there were no significant differences in the adjusted risk of death or myocardial infarction in patients with drug-eluting stents as compared with those with bare-metal stents, whereas the risk of repeat revascularization was significantly lower among patients with drug-eluting stents. CONCLUSIONS Among patients with off-label indications, the use of drug-eluting stents was not associated with an increased risk of death or myocardial infarction but was associated with a lower rate of repeat revascularization at 1 year, as compared with bare-metal stents. These findings support the use of drug-eluting stents for off-label indications.
Potenciar la prevención cardiovascular primordial y primaria para aumentar la esperanza de vida

The article by Garcı́a González published in the Revista Española de Cardiologı́a demonstrates that life expectancy (LE) in Spain has increased by more than 6 years over the last 20 years, and that slightly more than half of this increase is due to the reduction observed in the mortality associated with cardiovascular disease (CVD). This article is important for at least 2 reasons. First, because living longer, and better as well, has been an aspiration of the human being since the dawn of time; thus, the improvement in LE is closely related to the ‘‘Millennium Development Goals’’ of the United Nations, and LE is one of the most important indicators in the evaluation of health care policies. Second, because it illustrates the magnitude of the health gains that can be achieved by means of appropriate interventions against CVD. The findings of Garcı́a González agree with those obtained in other developed countries, in which the decrease in mortality due to CVD has also been accompanied by substantial increases in LE. However, one characteristic that is specific to Spain is that the decrease in mortality due to stroke has contributed more to the gain in LE than the reduction in mortality attributable to ischemic heart disease or other heart diseases. The gain in LE associated with the control of CVD has been somewhat greater in women (3.8 years) than in men (3.3 years). This circumstance is due to the concentration of the CVD burden, especially that of stroke, in more advanced age groups and the fact that more women reach those ages. Thus, the reduction in mortality due to CVD corresponds to 90% of the gain in LE in the oldest age groups. As in other countries of the Mediterranean basin, the risk of ischemic heart disease in Spain has traditionally been low. We recorded a certain increase in the mortality due to this condition in the sixties and seventies, but since then it has decreased continuously to date. In the case of stroke, in the middle of the last century Spain presented an intermediate mortality rate among the European countries, but the incidence has decreased uninterruptedly over the past 50 years; now, the rate of stroke
Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients.

BACKGROUND Delirium occurs commonly in hospitalized older patients but is poorly recognized. Although there are a plethora of validated delirium screening tools, it is unclear which tool best suits particular populations. PURPOSE To evaluate validation studies of delirium screening tools in non-critically ill hospital inpatients and provide guidance on the choice of screening tool. METHODS The MEDLINE, CINAHL, and PsychInfo databases were searched for studies comparing delirium bedside screening tools with either the Diagnostic and Statistical Manual or International Classification of Diseases defined diagnosis of delirium in hospital inpatients. Information was also drawn from conference proceedings and discussion with delirium researchers. RESULTS Thirty-one studies describing 21 delirium screening tools were included in the systematic review. The majority of studies were conducted across a broad range of inpatient settings internationally in elderly inpatients, including patients with dementia but most excluded nonnative language speakers. IMPLICATIONS The Confusion Assessment Method was the most widely used instrument to identify delirium, however, specific training is required to ensure optimum performance. The Delirium Rating Scale and its revised version performed best in the psychogeriatric population but requires an operator with psychiatric training. The Nurses' Delirium Screening Checklist appears best suited to the surgical and recovery room setting. The Single Question in Delirium shows promise in oncology patients. The Memorial Delirium Assessment Scale, while demonstrating good measures of validity in the surgical and palliative care setting, may be better used a measure of delirium severity. The 4As Test performed well when delirium was superimposed on dementia, but it requires further study.
The Trajectory of Tolerance for Wandering-related Boundary Transgression: An Exploration of Care Staff and Family Perceptions

Purpose of the Study This study aimed to explore the experience of living with and caring for a person with dementia who wanders and transgresses boundaries into out-of-bounds and potentially hazardous areas (wandering-related boundary transgression [BT]), from the perspective of family members and care staff. Design and Methods This descriptive qualitative study utilized four focus groups with care staff (n = 28), one with family members (n = 4), and individual interviews (n = 8) with family members. Content analysis generated key concepts that formed the basis of the development of a theoretical understanding of the experience. Results and Implications Care staff and families described wandering-related BT as a common dementia-related behavior in residential aged care (RAC). Drawing on the generated concepts, a complex theoretical trajectory of tolerance for BT was developed. At one end of the trajectory, BT was perceived as being beyond the control of the individual and when unwitnessed by others, having little or no impact. Tolerance for BT shifted when the BT was witnessed by others, and potentially unsafe consequences for the person who wanders or their coresidents were experienced. Under the latter circumstances, BT was perceived as a troubling behavior that needed more effective management. Underpinning the complexity of this behavior was a constantly shifting perception of how hazardous this behavior might be, a factor that appeared to contribute to the challenges faced by families and care staff.
Vitamin Analysis for the Health and Food Sciences

Fat-soluble vitamins Vitamin A and Carotenoids Review Properties Methods Method Protocols Vitamin D Review Properties Methods Method Protocols Vitamin E: Tocopherols and Tocotrienols Review Properties Methods Method protocols Vitamin K Review Properties Methods Method protocols 10:40:09 AM Water-soluble vitamins Ascorbic Acid: Vitamin C Review Properties Methods Status of Vitamin C Analysis Method Protocols Thiamin Review Properties Methods Method Protocols Riboflavin Review Properties Methods Method Protocols Niacin Review Properties Methods Method Protocols Vitamin B6 Review Properties Methods Method Protocols Folate and Folic Acid Review Properties: The Microgram Dietary Folate Equivalents Method Protocols Vitamin B12 Review Properties Methods Method Protocols Biotin Review Properties Methods Pantothenic Acid Review Properties Methods Multianalyte Methods for Analysis of the Fat- and Water-Soluble Vitamins Fat-Soluble Vitamins Water-Soluble Vitamins
A strategy to control transmission of Schistosoma japonicum in China.

BACKGROUND Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China. METHODS We evaluated a comprehensive control strategy in two intervention villages and two control villages along Poyang Lake in the southeastern province of Jiangxi, where annual synchronous chemotherapy is routinely used. New interventions, implemented from 2005 through 2007, included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines, providing boats with fecal-matter containers, and implementing an intensive health-education program. During the intervention period, we observed changes in S. japonicum infection in humans, measured the rate of infection in snails, and tested the infectivity of lake water in mice. RESULTS After three transmission seasons, the rate of infection in humans decreased to less than 1.0% in the intervention villages, from 11.3% to 0.7% in one village and from 4.0% to 0.9% in the other (P<0.001 for both comparisons). The rate of infection in humans in control villages fluctuated but remained at baseline levels. In intervention villages, the percentage of sampling sites with infected snails decreased from 2.2% to 0.1% in one grassland area and from 0.3% to no infection in the other (P<0.001 for both comparisons). The rate of infection in mice after exposure to lake water decreased from 79% to no infection (P<0.001). CONCLUSIONS A comprehensive control strategy based on interventions to reduce the rate of transmission of S. japonicum infection from cattle and humans to snails was highly effective. These interventions have been adopted as the national strategy to control schistosomiasis in China.
Accuracy of CT colonography for detection of large adenomas and cancers.

BACKGROUND Computed tomographic (CT) colonography is a noninvasive option in screening for colorectal cancer. However, its accuracy as a screening tool in asymptomatic adults has not been well defined. METHODS We recruited 2600 asymptomatic study participants, 50 years of age or older, at 15 study centers. CT colonographic images were acquired with the use of standard bowel preparation, stool and fluid tagging, mechanical insufflation, and multidetector-row CT scanners (with 16 or more rows). Radiologists trained in CT colonography reported all lesions measuring 5 mm or more in diameter. Optical colonoscopy and histologic review were performed according to established clinical protocols at each center and served as the reference standard. The primary end point was detection by CT colonography of histologically confirmed large adenomas and adenocarcinomas (10 mm in diameter or larger) that had been detected by colonoscopy; detection of smaller colorectal lesions (6 to 9 mm in diameter) was also evaluated. RESULTS Complete data were available for 2531 participants (97%). For large adenomas and cancers, the mean (+/-SE) per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90+/-0.03, 0.86+/-0.02, 0.23+/-0.02, 0.99+/-<0.01, and 0.89+/-0.02, respectively. The sensitivity of 0.90 (i.e., 90%) indicates that CT colonography failed to detect a lesion measuring 10 mm or more in diameter in 10% of patients. The per-polyp sensitivity for large adenomas or cancers was 0.84+/-0.04. The per-patient sensitivity for detecting adenomas that were 6 mm or more in diameter was 0.78. CONCLUSIONS In this study of asymptomatic adults, CT colonographic screening identified 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter. These findings augment published data on the role of CT colonography in screening patients with an average risk of colorectal cancer. (ClinicalTrials.gov number, NCT00084929; American College of Radiology Imaging Network [ACRIN] number, 6664.)
Implementing nutrition interventions in Ghana at district level: Gaps and opportunities

Malnutrition among women and children is an underlying cause of high morbidity and mortality in the developing world. Ghana is one of 36 countries with a high prevalence (> 20%) of chronic stunting in childhood. Although proven and inexpensive technologies and interventions exist to address maternal and child malnutrition, their implementation remains at a low scale in many developing countries, including Ghana. In Ghana, barriers to scaling up nutrition actions have been identified at the national level, yet little is known about the situation at the district and sub-district levels where nutrition interventions are directly delivered. The current study assessed district-level capacity and commitment for accelerating implementation of effective nutrition interventions to address the high burden of maternal and child malnutrition. In June 2010, key informant interviews involving technical officers, clinicians, nurses, and administrative staff, and a desk review of program and administrative reports were conducted in the Omanye District (pseudonym). Using the framework from the WHO landscape analysis of readiness to scale up nutrition actions, interviews explored questions of commitment (financial, planning, collaborations) and capacity (human resources, job aids, skills) to implement nutrition actions in the district. Most key nutrition interventions were being implemented in the Omanye District including growth promotion, micronutrient supplementation, behavior change communication on infant and young child feeding, and a pilot project for community management of severe acute malnutrition. Interventions are challenged, however, by barriers including inadequate financial commitment, low prioritization of nutrition, inadequate personnel, and insufficient job aids. Because nutrition was relatively underfunded in the district, nutrition technical officers had been shifted to perform other or additional tasks. Insufficient investment and inadequate capacity prevents delivery of quality nutrition services in the Omanye District. Interventions that prioritize and improve investment in nutrition actions are needed to optimize nutrition services at the district level in Ghana.
Effect of aspirin or resistant starch on colorectal neoplasia in the Lynch syndrome.

BACKGROUND Observational and epidemiologic data indicate that the use of aspirin reduces the risk of colorectal neoplasia; however, the effects of aspirin in the Lynch syndrome (hereditary nonpolyposis colon cancer) are not known. Resistant starch has been associated with an antineoplastic effect on the colon. METHODS In a randomized, placebo-controlled trial, we used a two-by-two design to investigate the effects of aspirin, at a dose of 600 mg per day, and resistant starch (Novelose), at a dose of 30 g per day, in reducing the risk of adenoma and carcinoma among persons with the Lynch syndrome. RESULTS Among 1071 persons in 43 centers, 62 were ineligible to participate in the study, 72 did not enter the study, and 191 withdrew from the study. These three categories were equally distributed across the study groups. Over a mean period of 29 months (range, 7 to 74), colonic adenoma or carcinoma developed in 141 participants. Of 693 participants randomly assigned to receive aspirin or placebo, neoplasia developed in 66 participants receiving aspirin (18.9%), as compared with 65 receiving placebo (19.0%) (relative risk, 1.0; 95% confidence interval [CI], 0.7 to 1.4). There were no significant differences between the two groups with respect to the development of advanced neoplasia (7.4% and 9.9%, respectively; P=0.33). Among the 727 participants receiving resistant starch or placebo, neoplasia developed in 67 participants receiving starch (18.7%), as compared with 68 receiving placebo (18.4%) (relative risk, 1.0; 95% CI, 0.7 to 1.4). Advanced adenomas and colorectal cancers were evenly distributed in the two groups. The prevalence of serious adverse events was low, and the events were evenly distributed. CONCLUSIONS The use of aspirin, resistant starch, or both for up to 4 years has no effect on the incidence of colorectal adenoma or carcinoma among carriers of the Lynch syndrome. (Current Controlled Trials number, ISRCTN59521990.)