Miracle-dz/UniFAR-FTUs huggingface dataset:
A 30-Week Randomized Controlled Trial of High-Dose Tacrine in Patients With Alzheimer's Disease

Objective. —To evaluate the efficacy and safety of high-dose tacrine hydrochloride over 30 weeks in patients with probable Alzheimer's disease. Design. —A 30-week randomized, double-blind, placebo-controlled, parallel-group trial. Setting. —Outpatients at 33 US centers. Patients. —Men and women at least 50 years of age with mild to moderate Alzheimer's disease and otherwise in good health. Interventions. —Group 1 received placebo; group 2 received 40 mg/d of tacrine for 6 weeks, then 80 mg/d for 24 weeks; groups 3 and 4 received 40 mg/d of tacrine for 6 weeks, 80 mg/d for 6 weeks, and 120 mg/d for 6 weeks. Group 3 remained on a dosage of 120 mg/d for a total of 18 weeks; after 6 weeks at 120 mg/d, group 4 titrated to 160 mg/d for the last 12 weeks. Primary Outcome Measures. —Clinician Interview-Based Impression (CIBI), Alzheimer's Disease Assessment Scale—Cognitive subscale (ADAS-Cog), and Final Comprehensive Consensus Assessment (FCCA). Results. —A total of 663 patients entered the study; 653 patients were included in an intent-to-treat (ITT) analysis; 263 had evaluable data at 30 weeks. The results of the ITT analysis revealed significant (P≤.05) dose-response trends and between-group comparisons on CIBI and ADAS-Cog. In evaluable patients, significant dose-response trends were observed for all three primary measures (P≤.001). Significant differences in favor of 160 mg/d of tacrine vs placebo were observed on the CIBI (P≤.002) and ADAS-Cog and FCCA (P≤.001), as well as caregiver-global and quality-of-life assessments (P≤.05). On the CIBI, 23% and 42% of tacrine-treated patients in the ITT and evaluable-patient populations, respectively, were rated improved compared with 17% and 18% of placebo patients, respectively. The primary reasons for withdrawal of tacrine-treated patients were asymptomatic liver transaminase elevations (28%) and gastrointestinal complaints (16%). These adverse events were reversible on discontinuation of treatment, and many patients were able to restart tacrine. Conclusions. —Tacrine produced statistically significant, dose-related improvements on objective performance-based tests, clinician- and caregiver-rated global evaluations, and measures of quality of life. There was no evidence that the large number of patient withdrawals biased the overall conclusions of the study. (JAMA. 1994;271:985-991)
Prognosis V/S Etiology: Midline Papilla Reconstruction after Closure of Median Diastema

Reconstruction of lost interdental papilla once the contact point is restored in midline diastema cases are as well important in restoring the esthetics as closure of diastema. Aim: The purpose of this study was to predict the midline papilla reconstruction in treated median diastema of variable etiology. Method : The treated sample consisted of 40 patients with variable etiology of midline diastema (6 of abnormal labial frenum, 6 of mesiodens ,8 of anodontia or microdontia, 8 of para functional habits, 6 of flared or rotated incisors and 6 of dentoalveolar disproportion) with otherwise healthy periodontium. The method used was PPI (papilla presence index) by D.Cardaropoli. Results: The study suggests that prognosis for papillary reconstruction is not good in cases of mesiodens. Conclusion: In spite of getting a good contact point, various other factors are playing a role in achieving good esthetics in cases of median diastema.
Asthma: Management during Pregnancy

Asthma is one of the most common diseases complicating pregnancy. Uncon trolled asthma can produce serious maternal and fetal complications; prompt initiation of effective treatment, both pharmacologic and nonpharmacologic, is critical. With attentive and appropriate management most asthmatics can anticipate a pregnancy outcome similar to an average uncomplicated pregnancy. In patients with severe asthma there remains a higher incidence of preterm delivery and low infant birth weights. The physiologic changes of pregnancy do not alter spirometry and peak expiratory flow rates, which can be employed to monitor the severity of asthma during pregnancy. Early fetal monitoring with sonography provides a benchmark for progressive fetal growth. Sequential sono graphic evaluations are indicated if asthma is moderate or severe or if growth retardation is suspected. Patients with anything more than mild occasional asthma should be treated with anti-inflammatory agents (inhaled steroids or cromolyn/nedocromil). Long-acting beta-2 agonists and/or theophylline can then be added. Only 10% of women with asthma have an exacerbation during labor. Patients receiving recent oral corticosteroids should receive stress dose steroids during labor and for 24 hours postpartum.
Analysis of MTCOI and MTCYB Sequence Variations in Eight Population Groups Living in Taiwan

Objectives: Identification of coding region polymorphisms in addition to hypervariable regions of different populations is helpful to increase the value of mitochondrial DNA (mtDNA) polymorphic data in forensic genetics. Methods: Haplotype frequencies of MTCOI and MTCYB sequences were determined in 565 individuals of eight population groups living in Taiwan, including Taiwanese Han, indigenous Taiwanese of Taiwan Island, Tao of Orchid Island, mainland Chinese, Filipinos, Thais, Vietnamese, and Caucasian. Results: There were 125 and 138 polymorphic sites with 128 and 139 substitutions formed in MTCOI and MTCYB, respectively. Sequence positions with high heterogeneity were observed. Among the 565 subjects, 222 different hyplotypes were observed for combination of MTCOI and MTCYB sequences, and 158 haplotypes were noted only once. The sequence of MTCYB was more polymorphic than which of MTCOI. The forensic parameters were calculated and a relatively high random match probability in the Tao population was noted. Population-specific polymorphisms were found is the Tao and Caucasian groups. Conclusions: The MTCOI and MTCYB sequences are polymorphic and population specific sequence polymorphisms have been found in these regions. These polymorphisms may be valuable in individual identification of forensic casework, population haplogrouping, and ethno- geographical sub-classification.
Fruits and vegetables moderate blood pressure, fibrinogen concentration and plasma viscosity in Nigerian hypertensives

Fruits and vegetables contain vital components such as potassium, antioxidants, vitamins and folic acid that might contribute to lowering blood pressure which is a major risk factor in cardiovascular disorders. However, the results of the few investigations on the correlation between intake of fruits and vegetables and cardiovascular disease have been inconsistent. Worse still, there is dearth of information on disease prevention with fruits and vegetables in Africans. Thus, we investigated the relative effect of fruits and vegetables on blood pressure, viscosity of blood and fibrinogen level. Ten weeks intervention study with ≥ 3 times daily consumption of fruits and vegetables by hypertensive patients was conducted. The fruits and vegetables included in the test diet were oranges, banana, pawpaw, mango, pineapple, grape, tangerine, garden egg, okra, pumpkin leaf, spinach, amaranthus and water leaf. The patients were allowed to consume the food servings while their eating habit was not restricted. Blood pressure, blood viscosity and plasma fibrinogen and nutrient intake were determined before and during intervention. The complementary fruits and vegetables included in the normal dietary regimen of the patients during the 10 weeks study increased the levels of potassium, calcium, phosphorus, antioxidants and dietary fiber significantly compared to the baseline values (P<0.01). The systolic and diastolic blood pressure were significantly lowered; percentage differences of – 9.01 and –3.73 (P<0.01) respectively were observed after 10 weeks. Percentage differences of –6.02, -38.86 and –5.29 (P<0.05.) were observed for haematocrit, blood viscosity and plasma fibrinogen respectively compared with the base line. Fruits and vegetables lowered the systolic and diastolic blood pressure, blood viscosity and plasma fibrinogen. The decrease in haematocrit and fibrinogen could influence reduction in blood viscosity thereby preventing premature CVD in hypertensive. Daily intake of fresh fruit and vegetable might be beneficial for the prevention and as therapeutic regime for cardiovascular complications. Key Words : Hypertension, Fruits, Vegetables, Fibrinogen, Viscosity
Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights

Until recently, atopic dermatitis (AD) has been linked to Th1/Th2 cell dysregulation. But now, the opinion that inflammation in AD results from a convergence of inherited and acquired insults to the cutaneous permeability barrier, with variable contributions from inherited abnormalities in innate/adaptive immunity, is becoming increasingly accepted. Current therapy is however, still largely directed towards ameliorating immunologically triggered inflammation, rather than correcting the barrier abnormality. In this article, the authors provide an overview of epidermal barrier function; a review of recent molecular genetic studies pointing to a primary barrier abnormality in AD; a detailed description of new pathogenic insights into AD; and they compare the efficacy of several putative ‘barrier repair’ products currently utilized as adjunctive or primary therapy for AD. The authors also explore the potential of ‘next-generation’ barrier repair approaches that attack specific pathogenic mechanisms in AD (hig.
Both The 'Private Option' And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults.

Under the Affordable Care Act, thirty states and the District of Columbia have expanded eligibility for Medicaid, with several states using Medicaid funds to purchase private insurance (the "private option"). Despite vigorous debate over the use of private insurance versus traditional Medicaid to provide coverage to low-income adults, there is little evidence on the relative merits of the two approaches. We compared the first-year impacts of traditional Medicaid expansion in Kentucky, the private option in Arkansas, and nonexpansion in Texas by conducting a telephone survey of two distinct waves of low-income adults (5,665 altogether) in those three states in November-December 2013 and twelve months later. Using a difference-in-differences analysis, we found that the uninsurance rate declined by 14 percentage points in the two expansion states, compared to the nonexpansion state. In the expansion states, again compared to the nonexpansion state, skipping medications because of cost and trouble paying medical bills declined significantly, and the share of individuals with chronic conditions who obtained regular care increased. Other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas's private option, which suggests that both approaches improved access among low-income adults.
Hormone replacement therapy and cardioprotection: a new dawn? A statement of the Study Group on Cardiovascular Disease in Women of the Italian Society of Cardiology on hormone replacement therapy in postmenopausal women

Cardiovascular disease is the leading cause of death in women in Western countries. Despite preventive strategies, in the past decades the incidence of cardiovascular events has shown a decline in men but a rise in women, matching the growth of the population of postmenopausal women. Several epidemiological findings suggest the causative pathophysiological role of ovarian hormone deficiency in the development of cardiovascular disease in women. Observational and randomized studies have suggested that hormone replacement therapy in early postmenopause could be beneficial from a cardiovascular point of view. Conversely, aging, time since menopause and presence of cardiovascular risk factors or cardiovascular disease may decrease its efficacy and increase the risk of cardiovascular events. It is plausible that the unfavorable effects of the estrogen/progestin combination used in the randomized studies are not related to the hormone preparation per se but rather to the use of hormones in the less receptive group of women, older and with cardiovascular risk factors. Clinical judgment, choice of the right dose and estrogen/progestin combination are of pivotal importance to maximize the beneficial effect of estrogen replacement therapy/hormone replacement therapy, especially if given within a reasonable time after the menopause to women who need the therapy for the relief of menopausal symptoms.
Epidural analgesia may be protective against third and fourth degree perineal trauma

Background We postulate that epidural analgesia during labour may be protective against 3rd/4th degree perineal trauma by reducing an uncontrolled urge to push at the point of delivery. Methods We retrospectively reviewed the data for all 18 229 consecutive vaginal deliveries in a tertiary obstetric unit in the North of England between January 2008 and December 2010 looking at 3rd/4th degree tear rates in those with and without an epidural, achieving a spontaneous or assisted vaginal delivery. Results Following spontaneous vaginal delivery the risk of 3rd/4th degree tear was significantly lower in the epidural group than in the no-epidural group (37 (1.9%) of 1989 vs 230 (2.7%) of 8564; relative risk 0.70 (95%CI 0.49 to 0.98) p<0.05). Following assisted vaginal delivery the risk of 3rd/4th degree tear was again significantly lower in the epidural group than in the no-epidural group (80 (4.6%) of 1746 vs 81 (6.9%) of 1176; relative risk 0.68 (95%CI 0.50 to 0.92) p<0.05). In this group the fourth degree tear rate was also significantly lower in those receiving an epidural compared to those who did not (4 (0.23%) of 1746 vs 10 (0.85%) of 1176; relative risk 0.27 (95%CI 0.08 to 0.86) p<0.05. The overall risk of sustaining a 3rd/4th degree perineal tear in those with an epidural was not different to those with no epidural (117 (3.1%) of 3735 vs 311 (3.2%) of 9740; relative risk0.98 (95%CI 0.79 to 1.21) p>0.05. Conclusion Despite the increased rates of assisted vaginal delivery associated with the epidural population, the reduced rates of 3rd/4th degree tear sustained at both spontaneous and assisted vaginal delivery by those receiving an epidural was sufficient to offset any rise that increased assisted delivery caused, supporting our hypothesis that epidural may be protective.
Complicaciones presentadas en pacientes mayores de 65 años ingresados por fractura de cadera en un hospital andaluz de tercer nivel

Purpose: To know the complications that occurred in patients over 65 years admitted to an Andalusian tertiary hospital during 2012 with a primary diagnosis of hip fracture. Methodology: Design: Cross-sectional study. Scope, period and cohort: Patients admitted in 2012 over 65 years with a primary diagnosis of hip fracture. Main outcomes: Morbidity and mortality collected in the Andalusian Minimum Data Set , analyzed in terms of other variables that influence their occurrence according to the literature (age, sex, comorbidity, etc). Instruments: Statistical analysis has been done with Epidat and G-Stat, statistical free software, to get and compare means and proportions of the variables. Results: The mean age was 83.16(6.68) years old. The mortality rate was 4.99%. The average length of stay was 10.2 days. Extracapsular fractures were more frequent than intracapsular ones, 64.24% and 35.76% respectively. The average preoperative stay was 3.5 days. The most frequent treatment was osteosynthesis, with 62.6%. The most common complication, excluding exitus, was “surgical urinary tract complications”. Total complicated patients was 8.7%, including the deceased. Male gender, older age and surgical delay was associated with development of complications. The highest percentages of complications occurred in patients with three comorbidities. Conclusion: The presence of complications during the period of hospitalization of elderly patients admitted for hip fracture is associated with male gender, older age, surgical delay and more comorbidities.
The Accuracy of Sonography in Detecting Abnormal Axillary Lymph Nodes When Breast Cancer Is Present

This study evaluated the accuracy of sonography in detecting abnormal ipsilateral axillary lymph nodes in women with breast cancer. The authors retrospectively reviewed the sonographic findings and surgical pathology reports of 71 women who were diagnosed with breast cancer by ultrasound-guided biopsies. Results found in 71 cases that the sonographic specificity was 82%, whereas the sensitivity was only 40%. In 8 of the 17 cases (47%), sonography was suspicious for cancer, and the final surgical pathology was malignant. In 42 of 54 cases (77%), sonography of the axilla was not suspicious, and the final axillary node surgical pathology was negative. In 12 cases, sonographic images of the lymph nodes appeared normal, whereas the surgical pathology of the axillary nodes demonstrated malignancy. Ultrasound imaging has a high specificity when evaluating axillary lymph nodes and can be recommended when a suspicious finding is detected in the breast during diagnostic breast sonographic examination.
Novel anticoagulants in clinical development: focus on factor Xa and direct thrombin inhibitors

Vitamin K antagonists are the mainstay in the prevention and treatment of thromboembolic diseases. Although effective under optimal conditions, several drawbacks are imminent to the long-term application of these drugs due to their narrow therapeutic window, interactions with other drugs as well as the need for regular monitoring and the risk of a recurrent event versus the risk of bleeding. To overcome these downsides, novel anticoagulants are being developed; in contrast to vitamin K antagonists, these novel agents specifically and selectively block central elements of the coagulation cascade. Several clinical trials have demonstrated the efficacy and safety of selective FXa inhibitors (such as fondaparinux, rivaroxaban, apixaban) and direct thrombin inhibitors (such as lepirudin, bivalirudin, dabigatran etexilate) in the treatment of typical indications for conventional vitamin K antagonists, in particular, the prevention and treatment of venous thromboembolism. This review summarizes the results and designs of recently published and ongoing clinical trials of novel anticoagulants.
Prevalence of urinary tract infection in Damietta diabetic patients

Aim of the work The aim of this observational study was to quantify the incidence of urinary tract infections (UTI) among diabetic patients and to compare this risk to patients without diabetes in Damietta hospital. Patients and methods This study included one thousand individuals (500 diabetic and 500 nondiabetic) examined for potential infections; assessment of history including age, sex, duration of diabetes, and treatment of diabetes, urine analysis and culture, total leukocyte count, blood sugar, serum creatinine, and glycated hemoglobin A1c was performed for each patient. Results The prevalence of UTI was 52.2%/500 diabetic patients, which was significantly higher than the prevalence of UTI in nondiabetic patients (22.4%/500 nondiabetic patients) (P < 0.001). There was a significant difference in the distribution of UTI in the diabetic and the nondiabetic group according to the history of previous UTI and total leukocytic count as diabetic patients had more previous UTI and increased total leukocytic count compared with nondiabetic patients (P < 0.001). In terms of the distribution of uropathogens in diabetic and nondiabetic patients with UTI, Escherichia coli was the most prominent uropathogen in both the diabetic and the nondiabetic group. Conclusion UTIs are more prevalent in individuals with diabetes mellitus (DM). The main risk factors for UTI in DM are inadequate glycemic control, duration of DM, diabetic microangiopathy, impaired leukocyte function, and anatomical and functional abnormalities of the urinary tract.
Behavioral, Psychological, Educational and Vocational Interventions to Facilitate Employment Outcomes for Cancer Survivors: A Systematic Review

In the United States, an estimated 1.5 million people are diagnosed annually with some type of cancer (American Cancer Society, 2011). Work is an important stabilizing factor for cancer survivors (Arnold, 1999). De Boer and colleagues (2009) identified a rate of 33.8% unemployment among cancer survivors beyond the age of 18 compared to 15.2% among a healthy international control population. Greater awareness of the job-related and workplace issues that cancer survivors face can lead to more comprehensive rehabilitation plans and recovery (Centers for Disease Control, 2011; Nathan, Hayes-Lattin, Sisler, & Hudson, 2011). Although various recent interventions have been developed to address unemployment among cancer survivors, these have not yet been systematically evaluated.
Does zinc supplementation improve dietary intake, symptoms of eating problems, and serum zinc levels in hemodialysis patients?

OBJECTIVE: The objectives of this study were to determine the effects of zinc supplementation on dietary intake, symptoms of eating problems, and serum zinc levels in hemodialysis patients. METHODS: Thirty-nine patients who received chronic maintenance hemodialysis were randomized to experimental (n 21) and placebo (n 18) groups given a daily supplement of 100 mg elemental zinc and corn starch, respectively, for 60 days. Dietary intake, body composition, and eating problems were assessed using 2-day dietary records, bioelectric impedance tests, and a questionnaire, respectively. Serum zinc levels were determined by atomic absorption before and after intervention. RESULTS: The mean daily macro- and micronutrients intakes and percentage of body fat in the supplemented group increased insignifi cantly. Administration of zinc improved appetite loss, dry mouth, nausea, and hypogeusia, while incidence of these symptoms increased in control group. A signifi cant increase (p 0.01) was observed in the mean serum zinc levels in the experimental group (102 4 vs. 76 3 g/dL) while changes in the placebo group were not signifi cant. CONCLUSIONS: Despite observed improvement in symptoms of eating problems and serum zinc levels in the supplemented group, more study over a longer period must be carried out to achieve clearer results.
Laparoscopic Adrenalectomy for isolated adrenal metastasis

Purpose: To report oncological outcome of laparoscopic treatment of metastases to the adrenal gland Patients and Methods: We retrospectively reviewed a prospectively maintained database to evaluate the outcome of 16 patients undergone laparoscopic adrenalectomy (LA) for adrenal metastasis. Preoperative data, perioperative results and follow-up were evaluated. Results: Nineteen LAs were performed in 17 patients. Pathologic analysis revealed renal cell carcinoma metastases in 11 patients and transitional cell carcinoma metastases in 2 men who underwent bilateral laparoscopic adrenalectomy. Metastasis from papillary renal cell carcinoma, poorly differentiate lung carcinoma, colorectal carcinoma and melanoma were respectively detected in the other four patients. Surgical margins were negative in all patients and local recurrence occurred in one patient. At a median follow-up of 21 months 12 patients were alive and 5 were disease free. Five out of 11 patients with metastatic renal cell carcinoma were recurrence free and 10 alive. Indeed no patients with primary tumor histology different by renal cell carcinoma was recurrence free and 4 out of those 5 five patients died of disease. Conclusion: Laparoscopic removal of adrenal metastasis is minimally invasive and oncologically effective. The final outcome of patients mainly depends on the primary tumor histology and on the chances of treatment of metastases subsequently developed.