Miracle-dz/UniFAR-FTUs huggingface dataset:
The incidence of upper and lower extremity surgery for rheumatoid arthritis among Medicare beneficiaries.

BACKGROUND For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder. METHODS We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period. RESULTS In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001). CONCLUSIONS Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis.
An Alumina Ceramic Total Talar Prosthesis for Osteonecrosis of the Talus.

BACKGROUND Treatment of osteonecrosis of the talus is challenging. Total talar replacement has the potential to restore the function of the ankle joint without an associated leg-length discrepancy. The purpose of the present study was to investigate postoperative function and pain after total talar replacement in patients with osteonecrosis of the talus. METHODS Fifty-five ankles in fifty-one consecutive patients with osteonecrosis of the talus who were treated with a total talar replacement from 2005 to 2012 were included in the investigation. Scores according to the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the Ankle Osteoarthritis Scale (AOS) were assessed before surgery and at the final follow-up evaluation. RESULTS According to the JSSF ankle-hindfoot scale, the score for pain improved from a mean (and standard deviation) of 15 ± 9.4 points (range, 0 to 20 points) to 34 ± 5.6 points (range, 20 to 40 points); the score for function, from 21.2 ± 9.7 points (range, 4 to 38 points) to 45.1 ± 4.0 points (range, 37 to 50 points); the score for alignment, from 6.0 ± 2.8 points (range, 5 to 10 points) to 9.8 ± 0.9 points (range, 5 to 10 points); and the total score, from 43.1 ± 17.0 points (range, 11 to 68 points) to 89.4 ± 8.4 points (range, 76 to 100 points). According to the AOS scale, the score for "pain at its worst" improved from a mean of 6.1 ± 3.3 points (range, 0 to 9.9 points) to 2.0 ± 1.7 points (range, 0 to 6.3 points). CONCLUSIONS Prosthetic talar replacement is a useful procedure for patients with osteonecrosis of the talus as it maintains ankle function.
A Routine Activity Theory Explanation for Women's Stalking Victimizations

Drawing on surveys administered to 861 university women in nine institutions, this article presents a routine activity theory model for predicting stalking victimization likelihood for women. Using routine activity theory, the model highlights lifestyle behaviors and interactions as predictors of stalking victimization. Whereas routine activity theory often highlights the role of demographics and statuses as predictors, this analysis emphasizes the role of women's social interactions and substance use in victimization risk. Significant predictors of victimization likelihood include substance use variables, activities in public settings, and residence off campus.
Improving Resident Performance in Knee Arthroscopy: A Prospective Value Assessment of Simulators and Cadaveric Skills Laboratories.

BACKGROUND Cadaveric skills laboratories and virtual reality simulators are two common methods used outside of the operating room to improve residents' performance of knee arthroscopy. We are not aware of any head-to-head comparisons of the educational values of these two methodologies. The purpose of this prospective randomized trial was to assess the efficacy of these training methods, compare their rates of improvement, and provide economic value data to programs seeking to implement such technologies. METHODS Orthopaedic surgery residents were randomized to one of three groups: control, training on cadavera (cadaver group), and training with use of a simulator (simulator group). Residents completed pretest and posttest diagnostic knee arthroscopies on cadavera that were timed and video-recorded. Between the pretest and posttest, the control group performed no arthroscopy, the cadaver group performed four hours of practice on cadavera, and the simulator group trained for four hours on a simulator. All tests were scored in a blinded, randomized fashion using the validated Arthroscopy Surgical Skill Evaluation Tool (ASSET). The mean improvement in the ASSET score and in the time to complete the procedure were compared between the pretest and posttest and among the groups. RESULTS Forty-five residents (fifteen per group) completed the study. The mean difference in the ASSET score from the pretest to the posttest was -0.40 (p = 0.776) in the control group, +4.27 (p = 0.002) in the cadaver group, and +1.92 (p = 0.096) in the simulator group (p = 0.015 for the comparison among the groups). The mean difference in the test-completion time (minutes:seconds) from the pretest to the posttest was 0:07 (p = 0.902) in the control group, 3:01 (p = 0.002) in the cadaver group, and 0:28 (p = 0.708) in the simulator group (p = 0.044 for the comparison among groups). Residents in the cadaver group improved their performance at a mean of 1.1 ASSET points per hour spent training whereas those in the simulator group improved 0.5 ASSET point per hour of training. CONCLUSIONS Cadaveric skills laboratories improved residents' performance of knee arthroscopy compared with that of matched controls. Residents practicing on cadaveric specimens improved twice as fast as those utilizing a high-fidelity simulator; however, based on cost estimation specific to our institution, the simulator may be more cost-effective if it is used at least 300 hours per year. Additional study of this possibility is warranted.
Final Results of Phase III Trial in Regionally Advanced Unresectable Non-Small Cell Lung Cancer : Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group

Study objectives The purpose of this phase III clinical trial was to test whether chemotherapy followed by radiation therapy resulted in superior survival to either hyperfractionated radiation or standard radiation in surgically unresectable non-small cell lung cancer. Design Patients were prospectively randomized to 2 months of cisplatin, vinblastine chemotherapy followed by 60 Gy of radiation at 2.0 Gy per fraction or 1.2 Gy per fraction radiation delivered twice daily to a total dose of 69.6 Gy, or 2.0 Gy per fraction of radiation once daily to 60 Gy. Patients were enrolled from January 1989 through January 1992, and followed for a potential minimum period of 5 years. Setting This trial was an intergroup National Cancer Institute–funded trial within the Radiation Therapy Oncology Group, the Eastern Cooperative Oncology Group, and the Southwest Oncology Group. Patients Patients with surgically unresectable non-small cell lung cancer, clinical stage II, IIIA, and IIIB, were required to have a Karnofsky Performance Status of≥ 70 and a weight loss of Conclusion Overall survival was statistically superior for the patients receiving chemotherapy and radiation vs the other two arms of the study. The twice-daily radiation therapy arm, although better, was not statistically superior in survival for those patients receiving standard radiation. Median survival for standard radiation was 11.4 months; for chemotherapy and irradiation, 13.2 months; and for hyperfractionated irradiation, 12 months. The respective 5-year survivals were 5% for standard radiation therapy, 8% for chemotherapy followed by radiation therapy, and 6% for hyperfractionated irradiation.
Progression of Hip Dysplasia in Mucopolysaccharidosis Type I Hurler After Successful Hematopoietic Stem Cell Transplantation.

BACKGROUND Dysostosis multiplex contributes substantially to morbidity in patients with Hurler syndrome (mucopolysaccharidosis type I Hurler phenotype [MPS I-H]), even after successful hematopoietic stem cell transplantation (HSCT). One of the hallmarks of dysostosis multiplex in MPS I-H is hip dysplasia, which often requires surgical intervention. We sought to describe in detail the course of hip dysplasia in this group of patients, as assessed by radiographic analysis, and to identify potential outcome predictors. METHODS Longitudinal data were obtained from digitally scored pelvic radiographs of patients with MPS I-H using OrthoGon software for parameters including, but not limited to, the acetabular index, migration percentage, Smith ratio, and neck-shaft angle. Scoring was performed independently by two blinded observers. Additional information on genotype, enzyme replacement therapy pre-HSCT, donor chimerism, and enzyme activity post-HSCT were obtained. General trends and potential correlations were calculated with mixed-model statistics. RESULTS Fifty-two patients (192 radiographs) were included in this analysis. Intraobserver and interobserver variation analysis showed an intraclass correlation coefficient ranging from 0.78 to 1.00. Among the twenty-one patients with follow-up beyond the age of five years, the acetabular index was in the range of severe hip dysplasia in up to 86% of the patients. Severe coxa valga was seen in 91% of the patients. Lateral and superior femoral displacement were highly prevalent, with the migration percentage outside the reference range in up to 96% of the patients. Finally, anterior pelvic tilt increased with age (p = 0.001). No correlations were identified between clinical parameters and radiographic findings. CONCLUSIONS Our study shows that progressive acetabular dysplasia as well as coxa valga and hip displacement are highly prevalent and progressive over time in patients with MPS I-H, despite successful HSCT. These data may provide essential natural history determinations for the assessment of efficacy of new therapeutic strategies aimed at improving skeletal outcomes in patients with MPS I-H.
Gender Differences in Response to Experimental Pain among Medical Students from a Western State of India

Background: Pain is one of the most common reasons for patients to seek medical attention and it causes considerable human suffering. Pain is a complex perception that differs enormously among individual patients. Gender plays an important role in how pain is experienced, coped with and treated. Even young healthy individuals often differ in how they perceive and cope with pain. This study was done to investigate gender differences in response to experimental pain among medical students from a western state of India. Methods: A total of 150 medical students (86 boys and 64 girls) participated in this interventional study. The Cold Pressor Test was used to exert experimental pain. To study the response, cardiovascular measures (radial pulse, systolic blood pressure and diastolic blood pressure) and pain sensitivity parameters (pain threshold, pain tolerance and pain rating) were assessed. Results: No significant difference was found in cardiovascular response to experimental pain between both the genders (p>0.05). Pain threshold and pain tolerance were found to be significantly higher in males whereas pain rating was found to be significantly higher in females (p<0.01). Pulse reactivity showed a negative relationship with pain threshold and pain tolerance whereas a positive relationship with pain rating, however no statistically significant relation was found between these measures. Conclusion: Females display greater pain sensitivity than men. Different pain perception might account for gender difference in pulse reactivity.
Tympanometric patterns in patients undergoing cartilage tympanoplasty of 0.6 mm thickness

Background: Tympanoplasty has been reported as early as in 1640 by Marcus Banzer, since then many different techniques have been developed for this procedure. The aim of this study is to analyze the tympanometric findings in those patients who underwent cartilage tympanoplasties of 0.6 mm thickness and in order to check different tympanometric patterns obtained in these patients. Materials and Methods: A prospective study was conducted on 60 patients diagnosed clinically with chronic suppurative otitis media in outpatient clinic between 2010 and 2013, in which a cartilage tympanoplasty of 0.6 mm thickness was planned. These patients were evaluated clinically and by pure tone audiograms and tympanograms for cartilage uptake and any late complications. Results: A total of 26 patients were included in our study. The male to female ratio was 3:1 and mean age was 36.1 years. The mean external canal volume of these patients was 0.928, and all of them had a closed air-bone gap. Ten patients had Type As tympanogram which represented 41.6%, 8 of these patients were females. The mean external canal volume of the patients with Type As tympanogram was 1.61. Only one patient had Type A tympanogram with external canal volume of 1.9 and a closed air-bone gap, he was a case of left cartilage tympanoplasty. Type B tympanogram was also found in only one patient who had left cartilage tympanoplasty, with external canal volume of 1.3 and a closed air-bone gap. No patients had Type C or Type Ac. Conclusion: Use of cartilage of 0.6 mm thickness in tympanoplasty for tympanic membrane perforation repair results in excellent outcomes and most common pattern of tympanogram is non-A, B, C postoperatively.
AUTHORS' RESPONSE TO LAMBERT LETTER ON SATURATED FAT INGESTION

Dr. Lambert has pointed out an important possibility to explain our results, which we have considered. However, we have some reservations on the mechanism of cholesterol impacting training responses through testosterone, which limits our enthusiasm. It is an attractive hypothesis since cholesterol is a precursor of testosterone, certain low fat diets reduce androgens, and there are indisputable effects of supraphysiological doses of testosterone and testosterone depletion (1) on skeletal muscle. In our study, lean mass and saturated fat intake were significantly correlated, but after adjusting for dietary cholesterol, the association was greatly reduced. This may support what Dr. Lambert alludes to, that the data on fat intake and androgens could be an artifact of the strong association between dietary saturated fat and dietary cholesterol. Although the rate-limiting step in steroid biogenesis is cholesterol transport into the mitochondria, it is not clear whether this process can be influenced by changes in dietary or blood cholesterol levels or whether this will change testosterone levels specifically. Our main reservation, however, is the minimal amount of evidence that normal variability in blood testosterone is associated with the normal variability in muscle gain with resistance training. For example, women only have 5%– 10% of the resting testosterone and no acute testosterone response to resistance training as compared to males (2), yet their short-term percent gains in muscle strength and mass are the same (3–4). To confound the issue further, testosterone responses to resistance training reported in the literature are inconsistent and seem to be context specific, some contexts that are inconsistent with skeletal muscle hypertrophy. For example, nutritional supplementation protocols known to enhance hypertrophy also have been shown to reduce or block testosterone responses to resistance training (2). In balance, some studies, but not all, have shown only ‘‘hypertrophy’’ training protocols increase testosterone, although bodybuilders tend not to have a response (2). In the two studies that we identified reporting a specific association of normal variability in testosterone to skeletal muscle adaptations (5,6), there were mixed effects on strength and mass and whether the association was with basal or exercise response of testosterone. If blood testosterone in the physiological range plays more than a permissive role in muscle responses, it may be due to specific increases in tissue sensitivity through increased receptor number or binding affinity shown to increase with exercise (7) or local
Traditional Healing Practices in Rural Nepal

Traditional healing practices in rural Nepal has emerged together with its culture and tradition. In the rural areas traditional culture is still predominant and western allopathic medicine has yet to reach those areas. People of rural societies are reluctant to accept changes in their cultural practices. There are also a lot of factors that make people choose traditional healers in lieu of modern hospital/heath post services. However, modern health services are slowly replacing traditional healing practices in rural parts of Nepal. DOI: http://dx.doi. org/10.3126/jpahs.v1i1. 13019 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):52-53
Nutrition and reproductive performance of dairy cattle. 1. The effect of level of feeding in late pregnancy and around the time of insemination on the reproductive performance of first lactation dairy heifers

One hundred first lactation Friesian dairy heifers were used to investigate the effect of level of nutrition n i late pregnancy and for a limited period around the time of insemination on reproductive performance. The heifers were housed throughout the period of the trial in cubicle yards and all individuals were given controlled amounts of food. Fifty animals were offered a ‘high’ (H) level of feeding in late pregnancy (for 10 weeks before calving) and 50 were offered a ‘low’ (L) level. After calving, the heifers were re-randomized with half of each pre-calving group being offered either the H or L level of feeding in early lactation (weeks 6 to 18), thus forming four subgroups of 25 heifers: HH, HL, LH and LL. The level of feeding in late pregnancy for all groups increased towards calving. The high plane heifers consumed 83·6 MJ metabolizable energy (ME) per day on average compared with 64·6 MJ ME per day for the low plane heifers, a proportional mean difference of 0·29 ( P P There were no significant effects of feeding treatments on milk yield. Fat yield in weeks 6 to 18 was increased by the high level of feeding in lactation ( P P P P P P P First ovulation occurred significantly earlier in heifers receiving the high level of feeding in pregnancy P ( P P P P P
Profil Resistensi Insulin pada Pasien Sindrom Ovarium Polikistik (SOPK) di RS Dr. Cipto Mangunkusumo Jakarta Elimination of Human Papillomavirus (HPV) and Therapy Response in Cervical Adenocarcinoma and squamous cell carcinoma cervix who received chemorad

Objective: The aim of the study was to investigate the difference of high risk DNA HPV elimination between cervical squamous cell carcinoma and cervical adenocarcinoma treated with chemoradiation and the possible correlation with the response to the chemoradiation. Material and method: Twenty two patients with cervical adenocarcinoma and 26 patients with cervical squamous cervical carcinoma who came to gynecologic oncology clinic of Dr. Cipto Mangunkusumo Jakarta between July 2005 and July 2006 (all the patients in both group were stage IB-IIIB according to International Federation of Gynecology and Obstetrics [FIGO] stadium) were tested using hybrid capture II (HC II) to identify the presence of high risk HPV DNA before they were treated with chemoradiation. After chemoradiation, the response was evaluated and all the patients were tested using HC II to determine the presensce of high risk HPV DNA after therapy. The clearance of HPV DNA and the response to chemoradiation in both group were studied. Results: Clearance of HPV DNA in squamous cell carcinoma group was non significantly higher than that in adenocarcinoma group. (76.9% vs 59.1%, p=0.310) and The persistance rate of HPV DNA in adenocarcinoma group was higher than that in squamous cell carcinoma group. This study showed that there was no difference in response to chemoradiation between adenocarcinoma group and squamous cell carcinoma group. Clearance of HPV DNA has no relation with response of therapy, even the tumour with complete response could still have a HPV DNA. Conclusion: Clearance of high risk HPV DNA was higher in cervical squamous cell carcinoma than in cervical adenocarcinoma. The persistence rate of high risk HPV DNA was higher in cervical adenocarcinoma than in cervical squamous cell carcinoma. Further study with longer follow up time is needed to prove the relation between the persistence of high risk HPV DNA and the recurrence of cervical cancer. Keywords: cervical cancer, HPV, chemoradiation
Species Diversity of Ramphogordius sanguineus/Lineus ruber-Like Nemerteans (Nemertea: Heteronemertea) and Geographic Distribution of R. sanguineus

Heteronemerteans, such as Lineus ruber, L. viridis, Ramphogordius sanguineus, R. lacteus, Riseriellus occultus, and Micrura varicolor, share many similar external characters. Although several internal characters useful for distinguishing these nemertean species have been documented, their identification is based mostly on coloration, the shape of the head, and how they contract, which may not be always reliable. We sequenced the mitochondrial COI gene for 160 specimens recently collected from 27 locations around the world (provisionally identified as the above species, according to external characters and contraction patterns, with most of them as R. sanguineus). Based on these specimens, together with sequences of 16 specimens from GenBank, we conducted a DNA-based species delimitation/identification by means of statistical parsimony and phylogenetic analyses. Our results show that the analyzed specimens may contain nine species, which can be separated by large genetic gaps; heteronemerteans with an external appearance similar to R. sanguineus/Lineus ruber/L. viridis have high species diversity in European waters from where eight species can be discriminated. Our 42 individuals from Vancouver Island (Canada) are revealed to be R. sanguineus, which supports an earlier argument that nemerteans reported as L. ruber or L. viridis from the Pacific Northwest may refer to this species. We report R. sanguineus from Chile, southern China, and the species is also distributed on the Atlantic coast of South America (Argentina). In addition, present analyses reveal the occurrence of L. viridis in Qingdao, which is the first record of the species from Chinese waters.