Miracle-dz/UniFAR-FTUs huggingface dataset:
Histological Comparison of Cold versus Hot Snare Resections of the Colorectal Mucosa

BACKGROUND: Delayed postpolypectomy bleeding occurs more frequently after hot resection than after cold resection. OBJECTIVE: To elucidate the underlying mechanism, we performed a histological comparison of tissue after cold and hot snare resections. DESIGN: This is a prospective study, registered in the University Hospital Medical Information Network (UMIN000020104). SETTING: This study was conducted at Aizu Medical Center, Fukushima Medical University, Japan. PATIENTS: Fifteen patients scheduled to undergo resection of colorectal cancer were enrolled. INTERVENTION: On the day before surgery, 2 mucosal resections (hot and cold) of normal mucosa were performed on each patient using the same snare without saline injection. The difference was only the application of electrocautery or not. Resection sites were placed close to the cancer to be included in the surgical specimen. MAIN OUTCOME MEASURES: The primary outcome measure was the depth of destruction. Secondary outcome measures included the width of destruction, depth of the remaining submucosa, and number of vessels remaining at the resection sites. The number and diameter of vessels in undamaged submucosa were also evaluated. RESULTS: All cold resections were limited to the shallow submucosa, whereas 60% of hot resections advanced to the deep submucosa and 20% to the muscularis propria (p < 0.001). There was no significant difference in the width of destruction. The number of remaining large vessels after hot resections trended toward fewer (p = 0.15) with a decreased depth of remaining submucosa (p = 0.007). In the deep submucosa, the vessel diameter was larger (p < 0.001) and the number of large vessels was greater (p = 0.018). LIMITATIONS: Histological assessment was not blinded to the 2 reviewers. Normal mucosa was used instead of adenomatous tissue. CONCLUSIONS: Hot resection caused damage to deeper layers involving more large vessels. This may explain the mechanism for the reduced incidence of hemorrhage after cold snare polypectomy. See Video Abstract at http://links.lww. com/DCR/A631.
Primary Colectomy in Patients With Stage IV Colon Cancer and Unresectable Distant Metastases Improves Overall Survival: Results of a Multicentric Study

BACKGROUND: Whether patients with stage IV colon cancer and unresectable distant metastases should be managed by primary colectomy followed by chemotherapy or immediate chemotherapy without resection of the primary tumor is still controversial. OBJECTIVE: This study aimed to evaluate predictive factors associated with survival in patients with stage IV colon cancer and unresectable distant metastases. DESIGN: This large retrospective multicentric study included 6 academic hospitals. SETTINGS: This study was conducted at 6 Paris University Hospitals (Assistance Publique-Hôpitaux de Paris; Saint Antoine, Henri Mondor, Ambroise Paré, Hôpital Europeen Gorges Pompidou, Bichat, and Avicenne). PATIENTS: Between 1998 and 2007, 208 patients with good performance status and stage IV colon cancer with unresectable distant metastases received chemotherapy, either as initial management or after primary tumor resection. MAIN OUTCOME MEASURES: Survival was estimated by use of the Kaplan-Meier method. Factors associated with survival were tested by means of a log-rank test. Results were expressed as median values with 95% confidence intervals. Factors independently related to survival were tested using a Cox regression model adjusted for a propensity score. RESULTS: Of the 208 patients, 85 underwent colectomy before chemotherapy, whereas 123 were treated with use of primary chemotherapy with or without biotherapy. At univariate analysis, the following factors were significantly associated with survival: primary colectomy (P = .031), secondary curative surgery (P < .001), well-differentiated primary tumor (P < .001), exclusive liver metastases (P < .027), absence of need for colonic stent (P = .009), and addition of antiangiogenic (P = .001) or anti-epidermal growth factor receptor (P = .013) drugs to chemotherapy. After Cox multivariate analysis and after adjusting for the propensity score, all of these factors, with the exception of two, colonic stent and anti-epidermal growth factor receptor drug, were found to be independently associated with overall survival. LIMITATION: This study was limited by its retrospective nature. CONCLUSIONS: In a selected population of patients with colon cancer and unresectable synchronous distant metastases, immediate colectomy followed by chemotherapy in association with targeted therapy was associated with longer overall survival. This strategy appears to be the most appropriate, especially for those with good performance status, well-differentiated tumors, and synchronous liver metastases only.
Long-term Efficacy and Safety of Sacral Nerve Stimulation for Fecal Incontinence

BACKGROUND AND OBJECTIVE: Sacral nerve stimulation is effective in the treatment of urinary incontinence and is currently under Food and Drug Administration review in the United States for fecal incontinence. Previous reports have focused primarily on short-term results of sacral nerve stimulation for fecal incontinence. The present study reports the long-term effectiveness and safety of sacral nerve stimulation for fecal incontinence in a large prospective multicenter study. DESIGN AND METHODS: Patients with fecal incontinent episodes more than twice per week were offered participation in this multicentered prospective trial. Patients showing ≥50% improvement during test stimulation were offered chronic implantation of the InterStim Therapy system (Medtronic; Minneapolis, MN). The aims of the current report were to provide 3-year follow-up data on patients from that study who underwent sacral nerve stimulation and were monitored under the rigors of an Food and Drug Administration-approved investigational protocol. RESULTS: One hundred thirty-three patients underwent test stimulation with a 90% success rate, of whom 120 (110 females) with a mean age of 60.5 years and a mean duration of fecal incontinence of 7 years received chronic implantation. Mean length of follow-up was 3.1 (range, 0.2–6.1) years, with 83 patients completing all or part of the 3-year follow-up assessment. At 3 years follow-up, 86% of patients (P < .0001) reported ≥50% reduction in the number of incontinent episodes per week compared with baseline and the number of incontinent episodes per week decreased from a mean of 9.4 at baseline to 1.7. Perfect continence was achieved in 40% of subjects. The therapy also improved the fecal incontinence severity index. Sacral nerve stimulation had a positive impact on the quality of life, as evidenced by significant improvements in all 4 scales of the Fecal Incontinence Quality of Life instrument at 12, 24, and 36 months of follow-up. The most common device- or therapy-related adverse events through the mean 36 months of follow-up included implant site pain (28%), paresthesia (15%), change in the sensation of stimulation (12%), and infection (10%). There were no reported unanticipated adverse device effects associated with sacral nerve stimulation therapy. CONCLUSIONS: Sacral nerve stimulation using InterStim Therapy is a safe and effective treatment for patients with fecal incontinence. These data support long-term safety and effectiveness to 36 months.
Improved serological response to H1N1 monovalent vaccine associated with viral suppression among HIV‐1‐infected patients during the 2009 influenza (H1N1) pandemic in the Southern Hemisphere

Patients infected with HIV‐1 were targeted for vaccination against H1N1 influenza because of their anticipated increased risk of mortality associated with H1N1 infection. Reports regarding the efficacy of vaccination in HIV‐1‐infected patients have suggested a reduced immunogenic response compared with the general population. Hence, the study aimed to determine the serological response to pandemic H1N1 influenza vaccine in HIV‐1‐infected patients in a clinical setting.
Seizing an Opportunity to Help—Knowledge and Attitudes of Doctors and Nurses Toward Women Victimized by Intimate Partner Violence in Brazil

In this study we combined quantitative (questionnaire survey of 221 health care professionals [HCPs]) and qualitative (interviews with 14 doctors) methods to explore knowledge and attitudes toward health service assistance for women victims of intimate partner violence (IPV). Data were collected in Ribeirão Preto, Brazil, in 2007. We found that most HCPs presented good knowledge of definitions of gender violence, but they had low awareness of its local prevalence, sympathetic attitudes to such women, but highlighted a range of barriers to assisting them. We analyzed these findings in relation to sex, age, profession, and years of experience.
Pooled week 96 results of the phase III DUET‐1 and DUET‐2 trials of etravirine: further analysis of adverse events and laboratory abnormalities of special interest

The aim of the study was to investigate the frequency and severity of adverse events (AEs) and laboratory abnormalities of interest over 96 weeks of treatment with etravirine or placebo in the pooled TMC125 DUET (Demonstrate Undetectable viral load in patients Experienced with ARV Therapy) trials.
Provider Barriers and Facilitators to Screening for Intimate Partner Violence in Bogotá, Colombia

We conducted interviews with 27 health care personnel in Bogotá, Colombia, to examine provider barriers and facilitators to screening for intimate partner violence (IPV). We used systematic qualitative analysis to identify the range and consistency of beliefs. We found that respondents did not routinely screen for IPV. Providers listed numerous barriers to screening. Ways to improve screening included increased clinician training, installing systematic IPV screening, providing patient education, and implementing health care setting interventions. Improving the care for IPV survivors will involve translating health care personnel preferred solutions into more systematic IPV screening interventions.
Single-Port Laparoscopic Diverting Sigmoid Colostomy

BACKGROUND: Single-port laparoscopic surgery has been described for various colorectal conditions. Here, we report the first 4 single-port laparoscopic sigmoid colostomies for fecal diversion. METHODS: A 1.5-cm-round incision was made on the skin at a previously marked colostomy site. A wound retractor was inserted and an access platform with four 5-mm trocars was attached to the wound retractor. The sigmoid colon was mobilized using electrocautery, laparoscopic scissors, or an advanced bipolar device. A standard Brooke colostomy was created through the initial skin incision. RESULTS: Four elective single-port laparoscopic diverting colostomies were performed. Indications included obstructing colon and rectal cancers and intractable Crohn's proctitis. The average operative time was 73 minutes (range, 53–105), and blood loss was minimal (<50 mL). There were no intraoperative complications. Three of 4 patients received oral analgesia, and one patient received patient-controlled intravenous analgesia postoperatively. The average time to passage of flatus was 1 day. Diet was advanced either on the day of surgery or on postoperative day 1. The length of hospital stay ranged from 0 to 15 days. CONCLUSION: Single-port laparoscopic sigmoid colostomy is an effective technique that allows full intra-abdominal visualization and colonic mobilization while eliminating the need for additional skin incisions other than the colostomy site itself.
Preoperative Diagnosis of Lynch Syndrome With DNA Mismatch Repair Immunohistochemistry on a Diagnostic Biopsy

BACKGROUND: DNA mismatch repair immunohistochemistry on tumor tissue is a simple, readily available, and cost-effective method of identifying patients with Lynch syndrome in the postoperative setting. The aim of the study was to assess whether the mismatch repair status of a colorectal cancer can be confirmed by mismatch repair immunohistochemistry on preoperative biopsy. DESIGN: Germline positive patients with Lynch syndrome were identified from a prospectively collected Familial Cancer Clinic database. Preoperative colorectal cancer biopsy specimens were obtained from the source pathology provider to generate a cohort of matched preoperative and postoperative specimens. The specimens were sectioned and stained for 4 mismatch repair proteins (MLH1, MSH2, MSH6, PMS2). An age-matched cohort to compare specimens was selected from Bethesda positive but mismatch repair immunohistochemistry negative patients. All slides were reviewed by a single blinded pathologist. The Wilson method was used to calculate a true underlying proportion of patients for whom the preoperative result matched the postoperative test result with a 95% confidence interval. RESULTS: Of 128 germline positive mutation carriers, 40 patients (mean age 41, SD 11.3) had colorectal resections. Thirty-three preoperative specimens were retrievable and were matched with biopsies from 33 controls. The germline mutations included in the study were 8 MLH1, 19 MSH2, 3 MSH6, and 2 PMS2. In patients where germline positive status was known, sensitivity was 100% (95% CI 89.2–100) and specificity was 100% (95% CI 89.2–100). Identical sensitivity and specificity were observed in 33 age-matched patients. The sensitivity of the endoscopic biopsy in predicting germline status was 94.9% (95% CI 80.4–98.3). CONCLUSION: The mismatch repair disease status of a colorectal cancer can be reliably confirmed by mismatch repair immunohistochemistry on a diagnostic colorectal cancer biopsy sample before definitive surgery. Ascertaining a diagnosis of Lynch syndrome before definitive surgery can influence surgical planning.
The Variation of Head Shapes in 17-20 Years Old Native Fars Male in Gorgan-North of Iran

El indice cefalico y la forma de la cabeza son afectados por factores geograficos, genero, edad y raza. El objetivo de este estudio fue determinar el indice cefalico y la forma de la cabeza en 200 hombres nativos de Gorgan-Norte de Iran, cuyas edades fluctuaban entre 17 y 20 anos de edad. El estudio descriptivo fue realizado a traves de cefalometria clasica. La media y DS del indice cefalico fue 84.8 + 6.9. El 52% de los individuos era hiperbraquicefalo, 25% braquicefalo, 21.5% mesocefalo y 1.5% doliocefalo. Los individuos nativos Fars eran tipicamente hiperbraquicefalos. En comparacion con otros estudios efectuados en el mundo, podemos determinar el rol del factor racial/etnico en los diametros cefalicos
The Sounds of Silence—A Hermeneutic Interpretation of Childbirth Post Excision

Four women who had been excised were interviewed about their experiences of giving birth. Using hermeneutic phenomenology we analyzed their narratives to more fully understand their experiences of childbirth in the context of excision. Childbirth is characterized by silence related to excision. To ensure safe care, increased communication is needed. The onus for opening channels of communication rests with health professionals whose aim is to provide safe, appropriate care to women and their families. In this article we give voice to women's call for sensitive communication that acknowledges their excision and supports them through the challenges it presents for birth.
Out-of-pocket expenses and healthcare resource utilization among individuals with or at risk of diabetes mellitus

ABSTRACT Objective: Self-reported healthcare resource utilization (HRU), medication out-of-pocket (OOP) expenditures and impact of OOP expenses on HRU were assessed for respondents with type 2 diabetes mellitus (T2DM) or elevated cardiometabolic risk. Methods: The 5-year longitudinal SHIELD study surveyed a stratified sample of US adults with diabetes or cardiometabolic risk factors (n = 22 001). High risk (HR) was defined as having 3−5 factors: abdominal obesity, BMI ≥ 28 kg/m2, dyslipidemia, hypertension, coronary heart disease, or stroke. Low risk (LR) was ≤2 factors. HRU included physician visits, admission to healthcare facilities, and medical tests during the preceding 12 months, as well as monthly medication OOP expenditures. Respondents reported whether OOP expenditures prevented them from seeking care or purchasing medications or supplies. Results: T2DM and HR respondents were significantly more likely than LR respondents to stay overnight in a healthcare facility or to visit the emergency room. T2DM respondents reported, on average, 12 visits to healthcare professionals compared with 10 for HR and 7 for LR (p < 0.0001). Monthly OOP expenditure for prescriptions was $108 for T2DM, $92 for HR, and $52 for LR (p < 0.0001). Approximately one third of respondents indicated that OOP expenses prevented them from buying medications. Overall, 37−41% of respondents indicated that OOP costs prevented them from seeking care or purchasing supplies or medications. Limitations: Self-selection bias may have occurred since the sample was respondents to a mailed survey. Healthcare resource utilization and out-of-pocket expenses were self-reported. Conclusions: More than one third of respondents with T2DM or HR reported that out-of-pocket expenses prevented them from seeking healthcare to manage their disease, which could speed disease progression or increase severity.
Urban‐rural differences in dietary habits and influences among Australian adolescents

Junior high school students (2,082) in Tasmania, Australia, were surveyed using a printed questionnaire. For 22 commonly‐used foods collectively, MANOVA indicated that rural students differed significantly from urban students in their consumption frequency for the foods, their perception of the usage of the foods by their parents and their friends, their liking for the foods and their perceptions of those foods’ healthfulness. Regression analyses for the 22 foods separately indicated that liking for a food and parental usage of it were generally significantly linked to the respondent's frequency of using it; there were few urban‐rural differences in this pattern. A food's healthfulness (as perceived by the respondent) and friends’ usage of it were significantly linked to personal usage frequency only for a minority of foods; the regression analyses suggested that rural students gave less weight than urban students to health considerations and to perceived peer behavior in their food choices. These results suggest differences in food cognition between urban and rural adolescents.
Emergence of quadratic gravity from entanglement equilibrium

In this work, we derive the linearised equations of quadratic gravity from entanglement equilibrium of local causal diamonds. Rather than starting from the Wald entropy prescription (which depends on the gravitational Lagrangian), we employ a model independent approach based on the logarithmic corrections to horizon entanglement entropy. In this way, we are able to show the emergence of linearised quadratic gravity from entanglement equilibrium without using any a priori knowledge about gravitational dynamics. If the logarithmic correction to entropy has a negative sign, as predicted by replica trick calculations of entanglement entropy, we find that the quadratic gravity correction terms have the sign necessary to avoid tachyonic instabilities of the theory.
Measuring Perinatal Health Equity and Migration Indicators for International Comparisons

An international research collaboration answered, “Can equity in perinatal health for migrant women be measured for comparison across countries? ” In nine countries, perinatal databases were assessed for the availability of equity indicators. Equity data were also sought from women and health records. Optimal sources of data differed depending on the migrant perinatal health equity indicator. Health and migration data, required to capture equity, were often not reported in the same location. Migration indicators other than country of birth were underreported. Perinatal health equity can be measured for international comparisons, although a standardized protocol is required to capture all indicators.
Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis

BACKGROUND: Although the perineal approach in the surgical management of rectal prolapse has a higher recurrence, it is the accepted approach for higher-risk patients because of its lower morbidity. OBJECTIVE: The aim of this study was to determine outcomes of abdominal versus perineal approaches to rectal prolapse repair. DESIGN SETTINGS: A retrospective study was performed comparing outcomes of patients undergoing different types of surgical approaches (open abdominal, laparoscopic, perineal) for rectal prolapse. PATIENTS: The American College of Surgeons National Surgical Quality Improvement Participant User Data Files (2008–2009) were queried for patients undergoing adult, elective procedures for rectal prolapse. MAIN OUTCOME MEASURES: Univariate analysis and multivariate logistic regression were performed to look at age, ASA classification, procedure type, and resultant mortality rate. RESULTS: One thousand four hundred sixty-nine patients meeting our criteria were identified. Older patients (age>80) and higher-risk patients (ASA classifications 3and 4) were significantly associated with the selection of the perineal approach. The overall mortality rate was 0.5%. The mortality rate for all perineal procedures was 0.9% in comparison with 0.13% for all abdominal operations (p = 0.033). The mortality rate for the highest-risk groups (ASA 3 and 4) for perineal procedures was 1.3% in comparison with 0.35% in the abdominal procedure group; the relative risk for mortality was 4 times greater in the perineal procedure group than in the abdominal procedure group. LIMITATIONS: The retrospective design and standardized outcomes measured use administrative-level data and prevent the assessment of procedure-specific outcomes. CONCLUSIONS: Hospital mortality for the surgical repair of rectal prolapse is uncommon. The decision to choose the abdominal approach for the repair of rectal prolapse may not be as prohibitive as previously thought for higher-risk patients. Because of the broad range of functionality within each ASA classification, the operation offered should always be individualized, and patient selection is the most important factor.
ASHA-Life Intervention Perspectives Voiced by Rural Indian Women Living With AIDS

In this focus group study, we explored the experiences of 16 rural women living with AIDS (WLA) who participated in the Asha-Life (AL) intervention to gain an understanding of the environmental, psychosocial, and cultural impact of the AL on their lives. Four themes emerged among AL participants: (a) the importance of tangible support, (b) need for social support, (c) ongoing challenges to accessing antiretroviral therapy (ART), and (d) perspectives on future programs. Our research findings support the development of future programs targeting mother–child dyads which emphasize nutritional knowledge, while reducing barriers to receiving ART, and physical, emotional, and financial support.