Miracle-dz/UniFAR-FTUs huggingface dataset:
Estrogen plus progestin and breast cancer incidence and mortality in the Women's Health Initiative Observational Study.

BACKGROUND In the Women's Health Initiative (WHI) randomized trial, estrogen plus progestin increased both breast cancer incidence and mortality. In contrast, most observational studies associate estrogen plus progestin with favorable prognosis breast cancers. To address differences, a cohort of WHI observational study participants with characteristics similar to the WHI clinical trial was studied. METHODS We identified 41 449 postmenopausal women with no prior hysterectomy and mammogram negative within 2 years who were either not hormone users (n = 25 328) or estrogen and progestin users (n = 16 121). Multivariable-adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). All statistical tests were two-sided. RESULTS After a mean of 11.3 (SD = 3.1) years, with 2236 breast cancers, incidence was higher in estrogen plus progestin users than in nonusers (0.60% vs 0.42%, annualized rate, respectively; HR = 1.55, 95% CI = 1.41 to 1.70, P < .001). Women initiating hormone therapy closer to menopause had higher breast cancer risk with linear diminishing influence as time from menopause increased (P < .001). Survival after breast cancer, measured from diagnosis, was similar in combined hormone therapy users and nonusers (HR = 1.03, 95% CI = 0.79 to 1.35). On a population basis, there were somewhat more deaths from breast cancer, measured from cohort entry (HR = 1.32, 95% CI = 0.90 to 1.93, P = .15), and more all-cause deaths after breast cancer (HR = 1.65, 95% CI = 1.29 to 2.12, P < .001) in estrogen plus progestin users than in nonusers. CONCLUSIONS Consistent with WHI randomized trial findings, estrogen plus progestin use is associated with increased breast cancer incidence. Because prognosis after diagnosis on combined hormone therapy is similar to that of nonusers, increased breast cancer mortality can be expected.
Probiotics for induction of remission in Crohn's disease.

BACKGROUND Crohn's disease has a high morbidity and there is no known cure. Current treatments have multiple side effects and an effective treatment with minimal side effects is desired. Probiotics have been proposed as such a treatment but their efficacy is undetermined. There is some evidence that probiotics are effective in other conditions affecting the gastrointestinal tract and they are popular with patients. They are thought to work through competitive action with commensal and pathogenic flora, influencing the immune response. OBJECTIVES To determine if there is any evidence for the efficacy of probiotics for the induction of remission in Crohn's disease. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2007), MEDLINE (1966 to 2007), Excerpta Medica/EMBASE (1974 to 2007), CINAHL (1982-2007) and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialised Trial Register were searched. Manufacturers of probiotics were also contacted to identify any unpublished trials. References of trials were also searched for any additional trials. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention for the induction of remission in Crohn's disease were eligible for inclusion. DATA COLLECTION AND ANALYSIS Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical remission. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes. MAIN RESULTS One small study (n = 11) met the inclusion criteria and was included in the review. There were some methodological concerns with this study. Four of 5 patients in the probiotic group achieved remission compared to 5 of 6 in the placebo group (OR 0.80; 95% CI 0.04 to 17.20). AUTHORS' CONCLUSIONS There is insufficient evidence to make any conclusions about the efficacy of probiotics for induction of remission in Crohn's disease. There is a lack of well designed RCTs in this area and further research is needed.
Dental anxiety in a Primary Attention Oral Health Service

Objective: To identify dental anxiety and determine the factors associated with its occurrence. Methods: Three hundred and fifteen individuals under treatment at the clinics of the Dental School of the Federal University of Minas Gerais participated in the study. The Modified Dental Anxiety Scale (MDAS) was used to identify dental anxiety and phobia. The MDAS is an instrument composed of 5 items with 5 alternatives each, especially developed to measure dental anxiety with scores from 5 to 25. Patients are considered anxious when present scores higher than 16, while scores above 19 indicate dental phobia. Information was collected about age, gender, educational level, income, history of avoided dental treatments and missed dental appointments. The significance level was set at p<0.05. Results: Dental anxiety and phobia were identified in 20% and 8.6% of the individuals, respectively. Women presented higher levels of anxiety than men. Lower educational level was associated with higher anxiety scores. Patients with higher anxiety scores tended to miss more dental appointments. Conclusion: Dental anxiety was frequent in the oral health service evaluated. There are multiple determinants for this condition, especially reports of postponed dental treatments and missed dental appointments. If the oral health service cannot reduce dental anxiety, it may create a barrier to patients’ access to the treatment.
Zinc supplements for preventing otitis media.

BACKGROUND Otitis media (OM) is inflammation of the middle ear and is usually caused by infection. It affects people of all ages but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries. As zinc supplements prevent pneumonia in disadvantaged children, we wanted to investigate whether zinc supplements could also prevent OM. OBJECTIVES To evaluate whether zinc supplements prevent OM in adults and children of different ages. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 1) which includes the Cochrane Acute Respiratory Infections Groups' Specialised Register, MEDLINE (1950 to February week 1, 2012) and EMBASE (1974 to February 2012). SELECTION CRITERIA Randomised, placebo-controlled trials of zinc supplements given at least once a week for at least a month for preventing OM. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and methodological quality of the included trials and extracted and analysed data. We summarised results using risk ratios (RRs) or rate ratios for dichotomous data and mean differences (MDs) for continuous data. We combined trial results where appropriate. MAIN RESULTS We identified 12 trials for inclusion, 10 of which contributed outcomes data. There was a total of 6820 participants. In trials of healthy children living in low-income communities, two trials did not demonstrate a significant difference between the zinc supplemented and placebo groups in the numbers of participants experiencing an episode of definite OM during follow-up (3191 participants); another trial showed a significantly lower incidence rate of OM in the zinc group (rate ratio 0.69, 95% confidence interval (CI) 0.61 to 0.79, n = 1621). A small trial of 39 infants undergoing treatment for severe malnutrition suggested a benefit of zinc for the mean number of episodes of OM (mean difference (MD) -1.12 episodes, 95% CI -2.21 to -0.03). Zinc supplements did not seem to cause any serious adverse events but a small minority of children were reported to have vomited shortly after ingestion of the supplements. The trial evidence included is generally of good quality, with a low risk of bias. AUTHORS' CONCLUSIONS Evidence on whether zinc supplementation can reduce the incidence of OM in healthy children under the age of five years living in low- and middle-income countries is mixed. There is some evidence of benefit in children being treated for marasmus (severe malnutrition) but this is based on one small trial and should therefore be treated with caution.
Current perspectives in bladder cancer management

More than 350,000 new cases of bladder cancer are diagnosed worldwide each year; the vast majority (> 90%) of these are transitional cell carcinomas (TCC). The most important risk factors for the development of bladder cancer are smoking and occupational exposure to toxic chemicals. Painless visible haematuria is the most common presenting symptom of bladder cancer; significant haematuria requires referral to a specialist urology service. Cystoscopy and urine cytology are currently the recommended tools for diagnosis of bladder cancer. Excluding muscle invasion is an important diagnostic step, as outcomes for patients with muscle invasive TCC are less favourable. For non‐muscle invasive bladder cancer, transurethral resection followed by intravesical chemotherapy (typically Mitomycin C or epirubicin) or immunotherapy [bacillus Calmette‐Guérin (BCG)] is the current standard of care. For patients failing BCG therapy, cystectomy is recommended; for patients unsuitable for surgery, the choice of treatment options is currently limited. However, novel interventions, such as chemohyperthermia and electromotive drug administration, enhance the effects of conventional chemotherapeutic agents and are being evaluated in Phase III trials. Radical cystectomy (with pelvic lymphadenectomy and urinary diversion) or radical radiotherapy are the current established treatments for muscle invasive TCC. Neoadjuvant chemotherapy is recommended before definitive treatment of muscle invasive TCC; cisplatin‐containing combination chemotherapy is the recommended regimen. Palliative chemotherapy is the first‐choice treatment in metastatic TCC.
Benefits, harms, and costs for breast cancer screening after US implementation of digital mammography.

BACKGROUND Compared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear. METHODS Using five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs. RESULTS For every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective. CONCLUSIONS The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.
Child abuse - clinical investigation, management and nursing approach

The overall aim of this thesis is to describe how children suspected of being abused were taken care of in a large Children’s University hospital. Did the medical staff clinically investigate possible child abuse when this would have been appropriate and what was documented in the child’s medical record? The secondary aim was to assess whether the medical staff followed the national legislation and reported suspected child abuse to the social services and finally to describe what the nursing staff experienced in their clinical encounters with children suspected of being victims of child abuse.
Objective measurement and clinical significance of TILs in non-small cell lung cancer.

BACKGROUND Tumor-infiltrating lymphocytes (TILs) are usually measured using subjective methods. Studies suggest that TIL subtypes have independent roles in cancer and that they could support the use of novel immunostimulatory therapies. We simultaneously measured TIL subtypes in non-small cell lung cancer (NSCLC) samples using objective methods and determined their relationship with clinico-pathologic characteristics and survival. METHODS Using multiplexed quantitative fluorescence (QIF), we measured the levels of CD3, CD8, and CD20 in 552 NSCLC from two independent collections represented in tissue microarrays (YTMA79, n = 202 and YTMA140, n = 350). The level of TILs was obtained in different tumor compartments using cytokeratin stain to define tumor cells and 4',6-Diamidino-2-Phenylindole. Association of TILs with clinical parameters was determined using univariate and multivariable analyses. All statistical tests were two-sided. RESULTS In both NSCLC collections there was a low correlation between the three TIL markers (linear regression coefficients (R(2)) = 0.19-0.22, P < . 001 for YTMA79 and R(2) = 0.23-0.32, P < . 001 for YTMA140). No consistent association between the level of TIL subtypes and age, sex, smoking history, tumor size, stage, and histology type was found. In univariate analysis, an elevated CD3 or CD8 signal was statistically significantly associated with longer survival in both collections. However, only CD8 was independent from age, tumor size, histology, and stage in multivariable analysis. High CD20 was associated with longer survival in the YTMA79 cohort. CONCLUSIONS Increased levels of CD3 and CD8 + TILs are associated with better outcome in NSCLC, but only CD8 is independent from other prognostic variables. Objective measurement of TIL subpopulations could be useful to predict response or evaluate the local immune effect of anticancer immune checkpoint inhibitors.
Hearing loss in Malawian children after bacterial meningitis: incidence and risk factors

We had an objective to describe the incidence and risk factors for hearing loss following acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. A double‐blind placebo‐controlled trial was designed from July 1997–March 2001 to determine whether early steroid therapy would reduce overall mortality and morbidity in childhood bacterial meningitis. The QECH, Blantyre, Malawi is a teaching and referral public hospital that serves the Blantyre area and receives referrals from throughout southern Malawi. Participants were children aged 2 months to 13 years, admitted with a diagnosis of bacterial meningitis, and the main outcome measures were mortality and morbidity following bacterial meningitis. Three hundred and ninety‐nine of 598 (66.7%) children survived; 33.6% were due to S. pneumoniae, 30% to Haemophilus influenzae type b, 15% to Neisseria meningitides, and 16% had no growth on CSF culture. Two hundred and sixty‐eight (67%) survivors had reliable hearing tests of whom 38% had impaired hearing, 77% of which was bilateral. Independent risk factors for hearing loss were the causative agent, presentation with a low coma score (52% vs. 34%, p = 0.006), a first CSF sample with a positive Gram stain for bacteria (65% vs. 44.3%, p = 0.003), a WBC < 100/cmm (p = 0.01), or a high protein level (50% if > 2000 mg/dl vs. 11% if <100 mg/dl). Associated neurological sequelae were highly associated with hearing impairment (p = 0.000012). We conclude that bacterial meningitis is the cause of many children's hearing impairment. Immunization against S. pneumoniae and H. influenzae would prevent many cases. Better first line antibiotics may reduce audiological damage. Deaf children in poorer parts of the world need more and vocal advocacy.
Predictors of pharmacological treatment outcomes with atomoxetine or methylphenidate in patients with attention‐deficit/hyperactivity disorder from China, Egypt, Lebanon, Russian Federation, Taiwan, and United Arab Emirates

The reduced availability of data from non‐Western countries limits our ability to understand attention‐deficit/hyperactivity disorder (ADHD) treatment outcomes, specifically, adherence and persistence of ADHD in children and adolescents. This analysis assessed predictors of treatment outcomes in a non‐Western cohort of patients with ADHD treated with atomoxetine or methylphenidate.
Allopurinol for preventing mortality and morbidity in newborn infants with hypoxic-ischaemic encephalopathy.

BACKGROUND Delayed neuronal death following a perinatal hypoxic insult is due partly to xanthine oxidase-mediated production of cytotoxic free radicals. Evidence exists that allopurinol, a xanthine-oxidase inhibitor, reduces delayed cell death in experimental models of perinatal asphyxia and in people with organ reperfusion injury. OBJECTIVES To determine the effect of allopurinol on mortality and morbidity in newborn infants with hypoxic-ischaemic encephalopathy. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Group. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2012, Issue 1), MEDLINE (1966 to March 2012), EMBASE (1980 to March 2012), CINAHL (1982 to March 2012), conference proceedings, and previous reviews. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that compared allopurinol administration versus placebo or no drug in newborn infants with hypoxic-ischaemic encephalopathy. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. MAIN RESULTS We included three trials in which a total of 114 infants participated. In one trial, participants were exclusively infants with severe encephalopathy. The other trials also included infants with mild and moderately severe encephalopathy. These studies were generally of good methodological quality, but were too small to exclude clinically important effects of allopurinol on mortality and morbidity. Meta-analysis did not reveal a statistically significant difference in the risk of death (typical risk ratio 0.88; 95% confidence interval (95% CI) 0.56 to 1.38; risk difference -0.04; 95% CI -0.18 to 0.10) or a composite of death or severe neurodevelopmental disability (typical risk ratio 0.78; 95% CI 0.56 to 1.08; risk difference -0.14; 95% CI -0.31 to 0.04). AUTHORS' CONCLUSIONS The available data are not sufficient to determine whether allopurinol has clinically important benefits for newborn infants with hypoxic-ischaemic encephalopathy. Much larger trials are needed. Such trials could assess allopurinol as an adjunct to therapeutic hypothermia in infants with moderate and severe encephalopathy and should be designed to exclude important effects on mortality and adverse long-term neurodevelopmental outcomes.
Treatment for POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome.

BACKGROUND POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome is a rare cause of demyelinating and axonal mixed neuropathy with multiorgan involvement and monoclonal plasma cell-proliferative disorder. The pathogenesis of POEMS syndrome is not well understood, but overproduction of vascular endothelial growth factor (VEGF), probably secreted by plasmacytomas, is likely to be responsible for most of the characteristic symptoms. POEMS syndrome is a potentially fatal disease, and patients' quality of life deteriorates because of progressive neuropathy, massive pleural effusion or ascites, or thromboembolic events. There is a need for efficacious therapy to improve prognosis. OBJECTIVES To provide the best available evidence from randomised controlled trials on treatment for POEMS syndrome. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (March 2008), MEDLINE (from January 1966 to March 2008), EMBASE (from January 1980 to March 2008) and CINAHL (from January 1982 to March 2008) for randomized controlled trials, quasi-randomized trials, historically controlled studies, and trials with concurrent controls. We adapted this strategy to search MEDLINE from 1966 and EMBASE from 1980 for comparative cohort studies, case-control studies and trials, and case series. SELECTION CRITERIA All randomized and quasi-randomized controlled trials, and non-randomized controlled studies were sought. Since we discovered no such clinical trials , we assessed and summarized all retrospective case series including five or more patients in the 'Discussion' section. DATA COLLECTION AND ANALYSIS Two authors independently reviewed and extracted details of all potentially relevant trials with any treatment for POEMS syndrome. We then collated and summarized information on the outcome. MAIN RESULTS We found no randomized or non-randomized prospective controlled trials of treatment for POEMS syndrome. We summarized the results of retrospective case series containing five or more patients in the Discussion section. AUTHORS' CONCLUSIONS There are no randomized or quasi-randomized controlled clinical trials of treatment for POEMS syndrome on which to base practice.
A Case Series of 25 Dogs with Chondrosarcoma

Summary The purpose of this study was to examine clinical, radiographic and histological features as well as post-diagnosis survival times of 25 dogs with chrondrosarcoma (CS). The diagnoses were made on histological evaluation of surgical biopsies or post-mortem specimens. Mixed breed dogs were found to be at higher risk. Chondrosarcoma of the proximal humerus was the most difficult to diagnose, clinically resembling a nerve sheath tumour and offering few gross abnormalities or radiographic changes. Chrondrosarcoma was transarticular in one case. The histological grading used was not well correlated with survival times; location of the CS seemed to be a better indicator of prognosis. Dogs with CS on a limb had the best survival rates, whereas those with CS of the vertebrae had the worst outcome. Surgery was beneficial in the cases of CS located on facial bones and limbs. The purpose of this paper was to examine the clinical and diagnostic features and survival rates of dogs with chondrosarcoma (CS). Histological diagnoses were made in all cases, mixed breeds were over represented. The location of the tumour was a better prognostic indicator than the histological grading. Dogs with CS on a limb had the longest survival times.