Miracle-dz/UniFAR-FTUs huggingface dataset:
Shoulder Arthroscopy: Basic Principles of Positioning, Anesthesia, and Portal Anatomy

&NA; Advances in modern arthroscopy have contributed significantly to greater flexibility and efficacy in addressing shoulder pathology. Advantages of arthroscopy include less invasive approaches, improved visualization, decreased risk of many postoperative complications, and faster recovery. As a result, arthroscopy is often preferred by both orthopaedic surgeons and patients. Common shoulder conditions that can be managed arthroscopically include rotator cuff tears, shoulder instability, and labral pathology. A thorough understanding of anatomic principles in conjunction with proper patient positioning and portal selection and placement are essential for successful arthroscopic shoulder surgery.
Administrative Databases in Orthopaedic Research: Pearls and Pitfalls of Big Data

The drive for evidence-based decision-making has highlighted the shortcomings of traditional orthopaedic literature. Although high-quality, prospective, randomized studies in surgery are the benchmark in orthopaedic literature, they are often limited by size, scope, cost, time, and ethical concerns and may not be generalizable to larger populations. Given these restrictions, there is a growing trend toward the use of large administrative databases to investigate orthopaedic outcomes. These datasets afford the opportunity to identify a large numbers of patients across a broad spectrum of comorbidities, providing information regarding disparities in care and outcomes, preoperative risk stratification parameters for perioperative morbidity and mortality, and national epidemiologic rates and trends. Although there is power in these databases in terms of their impact, potential problems include administrative data that are at risk of clerical inaccuracies, recording bias secondary to financial incentives, temporal changes in billing codes, a lack of numerous clinically relevant variables and orthopaedic-specific outcomes, and the absolute requirement of an experienced epidemiologist and/or statistician when evaluating results and controlling for confounders. Despite these drawbacks, administrative database studies are fundamental and powerful tools in assessing outcomes on a national scale and will likely be of substantial assistance in the future of orthopaedic research.
Determinantes do hábito de fumar e de seu abandono durante a gestação em localidade urbana na região sul do Brasil

Foi realizado um estudo transversal, com 873 gestantes que frequentaram o pre-natal em Pelotas (RS), em 1989-90, com o objetivo de investigar possiveis fatores de risco e fatores prognosticos para o tabagismo durante a gravidez. A prevalencia no inicio da gravidez foi de 40,8%. O habito de fumar da mae da gestante e do marido e a baixa escolaridade da mulher estiveram associados com o risco de fumar no inicio da gravidez. O tabagismo do marido esteve associado com um aumento de cerca de duas vezes nesse risco. A taxa de abandono ate a 15a-22a semana gestacional foi de 35,6%. A renda familiar, o habito de fumar da mae da gestante e do companheiro, a idade de inicio, duracao e intensidade do habito da mulher estiveram associados com a interrupcao durante a gravidez. Os resultados acima permaneceram apos ajuste para fatores de confusao, atraves de analise estratificada.
Radical cystectomy for the treatment of T1 bladder cancer: the Canadian Bladder Cancer Network experience.

BACKGROUND Radical cystectomy may provide optimal survival outcomes in the management of clinical T1 bladder cancer. We present our data from a large, multi-institutional, contemporary Canadian series of patients who underwent radical cystectomy for clinical T1 bladder cancer in a single-payer health care system. METHODS We collected a pooled database of 2287 patients who underwent radical cystectomy between 1993 and 2008 in 8 different centres across Canada; 306 of these patients had clinical T1 bladder cancer. Survival data were analyzed using Kaplan-Meier method and Cox regression analysis. RESULTS The median age of patients was 67 years with a mean follow-up time of 35 months. The 5-year overall, disease-specific and disease-free survival was 71%, 77% and 59%, respectively. The 10-year overall and disease-specific survival were 60% and 67%, respectively. Pathologic stage distribution was p0: 32 (11%), pT1: 78 (26%), pT2: 55 (19%), pT3: 60 (20%), pT4: 27 (9%), pTa: 16 (5%), pTis: 28 (10%), pN0: 215 (74%) and pN1-3: 78 (26%). Only 12% of patients were given adjuvant chemotherapy. On multivariate analysis, only margin status and pN stage were independently associated with overall, disease-specific and disease-free survival. INTERPRETATION These results indicate that clinical T1 bladder cancer may be significantly understaged. Identifying factors associated with understaged and/or disease destined to progress (despite any prior intravesical or repeat transurethral therapies prior to radical cystectomy) will be critical to improve survival outcomes without over-treating clinical T1 disease that can be successfully managed with bladder preservation strategies.
Laparoscopic pyeloplasty: the standard of care for ureteropelvic junction obstruction.

Open pyeloplasty has been the gold standard treatment for ureteropelvic junction obstruction (UPJO). Endopyelotomy, in spite of its inferior effectiveness, was sometimes preferred in select patients owing to its less invasive nature. Fortunately, over the past 2 decades a superior minimally invasive treatment has emerged with success rates equivalent to open pyeloplasty and complication rates equivalent to endopyelotomy. It is for good reason that laparoscopic pyeloplasty has become the new standard of care for the treatment of UPJO. Ureteropelvic junction obstruction is marked by renal outflow obstruction and may be asymptomatic or result in pain and complications, such as renal failure, pyelonephritis and calculus formation. Surgical management of UPJO aims to provide symptomatic relief and preserve remaining renal function. Today, treatment usually consists of either laparoscopic pyeloplasty or endopyelotomy. Its effectiveness, versatility and safety make laparoscopic pyeloplasty the optimal treatment for UPJO in virtually all circumstances.
A simple method to estimate renal volume from computed tomography.

INTRODUCTION Renal parenchymal volume can be used clinically to estimate differential renal function. Unfortunately, conventional methods to determine renal volume from computed tomography (CT) are time-consuming or difficult due to software limitations. We evaluated the accuracy of simple renal measurements to estimate renal volume as compared with estimates made using specialized CT volumetric software. METHODS We reviewed 28 patients with contrast-enhanced abdominal CT. Using a standardized technique, one urologist and one urology resident independently measured renal length, lateral diameter and anterior-posterior diameter. Using the ellipsoid method, the products of the linear measurements were compared to 3D volume measurements made by a radiologist using specialized volumetric software. RESULTS LINEAR KIDNEY MEASUREMENTS WERE HIGHLY CONSISTENT BETWEEN THE UROLOGIST AND THE UROLOGY RESIDENT (INTRACLASS CORRELATION COEFFICIENTS: 0.97 for length, 0.96 for lateral diameter, and 0.90 for anterior-posterior diameter). Average renal volume was 170 (SD: 36) cm(3) using the ellipsoid method compared with 186 (SD 37) cm(3) using volumetric software, for a mean absolute bias of -15.2 (SD 15.0) cm(3) and a relative volume bias of -8.2% (p < 0.001). Thirty-one of 56 (55.3%) estimated volumes were within 10% of the 3D measured volume and 54 of 56 (96.4%) were within 30%. CONCLUSION Renal volume can be easily approximated from contrast-enhanced CT scans using the ellipsoid method. These findings may obviate the need for 3D volumetric software analysis in certain cases. Prospective validation is warranted.
Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: Laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy.

INTRODUCTION We evaluate patient-reported satisfaction and cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) in comparison with that of conventional laparoscopic adrenalectomy (CLA). METHODS A total of 19 and 104 patients who respectively underwent LESS-A and CLA between May 1996 and June 2011 were included in the study. Questionnaires inquiring about scar pain (0: not painful, 10: very painful), satisfaction (0: not satisfied, 10: very satisfied) and cosmesis (0: very unsightly, 10: very beautiful) on the basis of a visual analogue scale were sent to patients postoperatively. RESULTS The respondents consisted of 11 and 54 patients who underwent LESS-A and CLA, respectively. There was no significant inter-group difference in age, sex, affected side or body mass index. No significant differences were observed in operative time or estimated blood loss. There were also no significant differences in pain (0.67 vs. 0.57, p = 0.393), satisfaction (8.92 vs. 8.46, p = 0.453), or cosmesis score (8.58 vs. 8.00, p = 0.487) between the LESS-A and CLA groups overall. In female patients, the satisfaction score was significantly higher in the LESS-A group than in the CLA group (10.0 vs. 8.72, p = 0.049). In young patients (<50 years old), the satisfaction score was also significantly higher in the LESS-A group than in the CLA group (9.17 vs. 6.38, p = 0.036). CONCLUSIONS Young patients and female patients who had received LESS-A adrenal surgery were more satisfied with the scar outcomes than were the young patients and female patients who had received CLA. We suggest that this patient subset most values the cosmetic benefits of LESS-A.
Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy.

INTRODUCTION Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopy time, effective dose) and investigates variables that may predict increased exposure. METHODS A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure. RESULTS In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m(2) and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose. CONCLUSIONS Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.
The burden of symptomatic skeletal events in castrate-resistant prostate cancer patients with bone metastases at three Canadian uro-oncology centres.

INTRODUCTION Metastatic bone disease in castrate-resistant prostate cancer risks significant morbidity, including symptomatic skeletal events. We estimated the healthcare resource costs of managing skeletal events. METHODS A retrospective chart review was conducted for patients who died from or were treated palliatively for metastatic castrate-resistant prostate cancer from 2006-2013 at Centre Hospitalier de l'Université de Montréal (Montreal), Princess Margaret Cancer Centre (Toronto), or Vancouver General Hospital (Vancouver). RESULTS Of 393 patients, 275 (70%) experienced 833 events (85 per 100 patient-years), with a median (95% confidence interval) time (months) to first event of 17.6 (15.3, 21.7). The mean metastatic bone disease-related healthcare resource use cost (2014 Canadian dollars) estimate for patients without symptomatic skeletal events was $9550 and between $22 101 (observed) and $34 615 (adjusted) for patients with at least one event. Fewer patients in Montreal (55%) experienced events compared to Toronto (79%) or Vancouver (76%). Median time (months) to first event was longer in Montreal (25.0 [18.5, 32.6]) than in Toronto (14.6 [9.7, 16.8] or Vancouver (17.3 [14.8, 24.0]). More patients received bone-targeted therapy in Montreal (64%) and Toronto (60%) than in Vancouver (24%). Bone-targeted therapy was mostly administered every 3-4 weeks in Montréal and every 3-4 months in Toronto. CONCLUSIONS Metastatic bone disease-related healthcare resource use costs for Canadian castrate-resistant prostate cancer patients are high. Symptomatic skeletal events occurred frequently, with the incremental cost of one or more events estimated between $12 641 and $25 120. Symptomatic skeletal event incidence and bone-targeted therapy use varied considerably between three Canadian uro-oncology centres. An important limitation is that only patients who died from prostate cancer were included, potentially overestimating costs.
Attitudes and Experience of Drug Use Amongst a Group of London Teenagers

Data are provided from the experiences of 23 young drug users recruited from the London area. Respondents reported a wide range of illicit drug use, centred on the so-called 'dance' drugs of MDMA, LSD and amphetamine sulphate. Friendship networks were important in the initiation and maintenance of drug use. Heroin and injecting were viewed negatively by the majority of respondents. Cocaine was seen in a more positive light, though many felt that it had damaging addictive properties. In the broader context of the young people's lifestyles, drugs were not viewed as a priority. Most stated that being with friends and family was the main priority in their lives. Most reported good levels of communication with parents, most of whom either approved or did not overtly object to some forms of illicit drug use by their children. The data suggest implications for health promotion and drug prevention. Peer education should be encouraged amongst networks of young drug users (where possible involving parents) and musi.
Serum Uric Acid and Mortality Form Cardiovascular Disease: EPOCH-JAPAN Study.

AIM To investigate the relationship between serum uric acid levels and cardiovascular disease in Asians. METHODS We examined the above relationship using the data of Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN Study). The data of 36,313 subjects (15,628 men and 20,685 women aged 35-89 years without histories of stroke, coronary heart disease, or cancer at baseline) were used for the analyses. Sex-specific hazard ratios (HRs) of mortality from cardiovascular disease were estimated according to the quintiles of serum uric acid using Cox hazard models stratified by cohorts. RESULTS During 441,771 person-years of follow-up, we documented 1,288 cardiovascular deaths. A J- or U-shaped relationship between serum uric acid level and cardiovascular disease mortality was observed. Compared with the lowest quintile of serum uric acid levels, the highest quintile was associated with an increased cardiovascular disease mortality in men [HR: 1.28; 95% confidence interval (CI): 1.01-1.63] and women (HR: 1.51; 95% CI: 1.14-1.99). However, there was no significant association with mortality from stroke, coronary heart disease or heart failure in both men and women. CONCLUSION This large pooled analysis in Japan suggested a J- or U-shaped relationship between serum uric acid levels and cardiovascular mortality. The highest quintile of serum uric acid levels was associated with increased cardiovascular disease mortality in both Japanese men and women.
Beneficial Effects of Exercise-Based Cardiac Rehabilitation on High-Density Lipoprotein-Mediated Cholesterol Efflux Capacity in Patients with Acute Coronary Syndrome.

AIM Recent studies reported that low high-density lipoprotein (HDL)-mediated cholesterol efflux capacity rather than low HDL cholesterol (HDL-C) is strongly associated with the increased risk for coronary artery disease. It remains unclear whether exercised-based cardiac rehabilitation (CR) can increase HDL cholesterol efflux capacity. METHOD This study is a retrospective analysis of stored serum from patients with acute coronary syndrome (ACS) who participated in outpatient CR program following successful percutaneous coronary intervention. We employed a cell-based cholesterol efflux system including the incubation of (3)H-cholesterol labeled macrophages with apolipoprotein B-depleted serum at the onset or early phase of ACS and at 6-month follow-up periods in 57 male and 11 female patients with ACS. Cardiopulmonary exercise tests were performed at the beginning and end of CR program. RESULT Fifty-seven patients completed the CR program. Compared with patients who dropped out from CR program (non-CR group), CR participants showed marked amelioration in serum lipid levels, increased efflux capacity, and improved exercise capacity. Spearman's rank correlation coefficient analysis revealed that the percent increases of efflux capacity were significantly associated with the percent increases in HDL-C (ρ=0.598, p＜0.0001) and apolipoprotein A1 (ρ=0.508, p＜0.0001), whereas no association between increases in efflux capacity and increases in cardiopulmonary fitness was observed. Increases in cholesterol efflux capacity were not seen in patients who continued smoking and those who did not achieve all risk factor targets and higher exercise tolerance. CONCLUSION CR can markedly increase both HDL-C and HDL cholesterol efflux capacity. These results suggest that CR is a very useful therapy for reverse cholesterol transport and secondary prevention.
Reduction in High-Sensitivity C-Reactive Protein Levels in Patients with Ischemic Stroke by Statin Treatment: Hs-CRP Sub-Study in J-STARS

Aims: The pleiotropic effects of statins on recurrent stroke remain unclear. We investigated the effects of pravastatin on high-sensitivity C-reactive proteins (Hs-CRP) in ischemic stroke, and explored the impact of Hs-CRP on recurrent stroke and vascular events. Methods: This randomized open-label trial was ancillary to the J-STARS trial. One thousand and ninety-five patients with non-cardiogenic ischemic stroke were assigned to the pravastatin (n = 545) or control groups (n = 550). The primary and secondary endpoints were serum Hs-CRP reduction and stroke recurrence, including both ischemic and hemorrhagic ones, respectively. Onset of vascular events and each stroke subtype in relation to Hs-CRP levels were also determined. Results: In the pravastatin treatment group, Hs-CRP levels (median 711 µg/L, IQR 344–1500) significantly decreased 2 months later (median 592 µg/L, IQR 301–1390), and they remained significantly lower until the end of the study. However, in the control group, baseline Hs-CRP levels were similar to those 2 months later. The reduction of Hs-CRP levels from the baseline to 2 months in the pravastatin group was statistically significant compared with the control (p = 0.007). One SD increase in log-transformed Hs-CRP increased the risk of stroke recurrence (HR 1.17, 95% CI 0.97–1.40) and vascular events (HR 1.30, 95% CI 1.12–1.51). With an Hs-CRP cut-off of 1000 µg/L, higher Hs-CRP significantly increased the risk of recurrent stroke (HR 1.50, 95% CI 1.03–2.17) and vascular events (HR 1.68, 95% CI 1.23–2.29). Conclusion: In non-cardiogenic ischemic stroke, pravastatin treatment may reduce vascular inflammation as assessed by Hs-CRP, and higher Hs-CRP levels appeared to increase the risk of recurrent stroke and vascular events.
Efficacy of Low-Dose (0.3 mg) Conjugated Estrogen Cream for Managing Atrophic Vaginitis

Objectives: To evaluate efficacy and safety of low-dose conjugated estrogen cream (0.3 mg) for treatment of atrophic vaginitis in postmenopausal women. Methods and Methods: A double-blind, placebo-controlled, randomized trial was conducted during November 2012 and September 2013, involving 73 postmenopausal women with symptomatic atrophic vaginitis and vaginal maturation index (VMI) ≤ 55. Participants were randomly assigned to receive conjugated estrogen cream 0.3 mg or placebo twice a week for 12 weeks. The primary outcome was the change in the mean of VMI from baseline. Endometrial thickness was assessed by transvaginal sonography. Results: 73 women were randomized into two group: 36 women in study group and 37 women in control group. All participants were completely follow up. Mean change of VMI in intervention group was significant higher than placebo group (34.5 ± 19.7 versus -0.6 ± 14.4, p<0.001). The mean change of VMI at 4 weeks was significantly higher in study group (21.2 ± 18.9 versus 1.3 ± 12.6, < 0.001). A significant greater reduction from baseline in vaginal pH at 12 weeks was shown in study group (-1.4 ± 1.0 versus -0.1 ± 0.9, p<0.001). Conclusions: Low-dose estrogen cream was superior to placebo in the mean change of VMI, decrease in vaginal pH and improved vaginal symptoms after 12 weeks of administration without increasing of endometrial thickness.
Transforming growth factor-β1 polymorphisms and chronic obstructive pulmonary disease: a meta-analysis.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a complex polygenic disease in which gene- environment interactions play a critical role in disease onset and progression. Transforming growth factor-β 1 (TGF-β 1) is one of several candidate loci for the pathogenesis of COPD, and is highly polymorphic. OBJECTIVE To derive a more precise estimation of the relationship between the T869C and C-509T polymorphisms of the TGF-β 1 gene and COPD, a meta-analysis of 11 published case-control studies was performed. METHODS Ten studies with 1507 cases and 2542 controls for T869C polymorphism and six studies with 955 cases and 2136 controls for C-509T polymorphism were included. The pooled odds ratios were performed respectively for allele contrasts, additive genetic model, dominant genetic model and recessive genetic model. A subgroup analysis was also performed by ethnicity for T869C polymorphism. RESULTS With respect to T869C polymorphism, a significant association of TGF-β 1 gene polymorphism at 869T/C with COPD was observed in the overall analysis (C vs. T: OR 0.82, 95%CI 0.70-0.96, P = 0.01). In the subgroup analysis by ethnicity, significant risks were also found in the Caucasian population for C vs. T (OR 0.77, 95%CI 0.60-0.98, P = 0.03), but not in the Asian population (C vs. T: OR 0.88, 95%CI 0.76-1.03, P = 0.10). With respect to C-509T polymorphism, no significant association with COPD was demonstrated in the overall analysis (T vs. C: OR 0.84, 95%CI 0.68- 1.04, P = 0.11). CONCLUSION Potentially functional TGF-β 1 T869C polymorphism may play a low penetrance role in COPD susceptibility in an ethnicity-specific manner.