Miracle-dz/UniFAR-FTUs huggingface dataset:
Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy.
Cooking Up Christmas in Kentucky: Occupation and Tradition in the Stream of Time

Abstract What makes the Christmas meal successful “is just having family all together and sharing. ” This statement summarizes the meaning of the Christmas meal for the older women in rural Kentucky who participated in this study. Older women in eastern Kentucky are the orchestrators of this important, ritual meal, as were their mothers and grandmothers before them. This paper presents the Kentucky findings from a multi‐site research project exploring older women's experiences of food related occupations at Songkran in Chiang Mai, Thailand, and Christmas in Auckland, New Zealand and Eastern Kentucky, USA. Data were collected through three focus group interviews from 23 eastern Kentucky women aged 65 and older. The narratives of these women revealed rich and complex interrelationships among the food occupations of the elder women, the matrilineal transmission of women's family and cultural roles, and the women's ability to adapt physically, temporally and emotionally to aging and to familial and cultural change.
Neck Movement and Muscle Activity Characteristics in Female Office Workers With Neck Pain

Study Design. Cross-sectional study. Objective. To explore aspects of cervical musculoskeletal function in female office workers with neck pain. Summary of Background Data. Evidence of physical characteristics that differentiate computer workers with and without neck pain is sparse. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius (UT) muscles during specific tasks. Understanding cervical musculoskeletal function in office workers will better direct intervention and prevention strategies. Methods. Measures included neck range of motion; superficial neck flexor muscle activity during a clinical test, the craniocerivcal flexion test; and a motor task, a unilateral muscle coordination task, to assess the activity of both the anterior and posterior neck muscles. Office workers with and without neck pain were formed into 3 groups based on their scores on the Neck Disability Index. Nonworking women without neck pain formed the control group. Surface electromyographic activity was recorded bilaterally from the sternocleidomastoid, anterior scalene (AS), cervical extensor (CE) and UT muscles. Results. Workers with neck pain had reduced rotation range and increased activity of the superficial cervical flexors during the craniocervical flexion test. During the coordination task, workers with pain demonstrated greater activity in the CE muscles bilaterally. On completion of the task, the UT and dominant CE and AS muscles demonstrated an inability to relax in workers with pain. In general, there was a linear relationship between the workers’ self-reported levels of pain and disability and the movement and muscle changes. Conclusion. These results are consistent with those found in other cervical musculoskeletal disorders and may represent an altered muscle recruitment strategy to stabilize the head and neck. An exercise program including motor reeducation may assist in the management of neck pain in office workers.
Análise da função autonômica cardíaca em hamsters chagásicos

propos a teoria neurogenica para o desenvolvimentoda cardiopatia chagasica cronica, no qual a destruicao preferencialdos gânglios intra-cardiacos vagais, por contiguidade anatomica como tecido miocardico inflamado na fase aguda, levaria a uma disfuncaovagal cronica com prevalencia a longo prazo do sistema nervososimpatico, reconhecidamente deleterio ao coracao. Entretanto, variosachados, tais como, coracoes chagasicos com miocardiopatia econtagem neuronal normal, disfuncao autonomica cardiacaimportante sem cardiopatia e lesao simultânea do simpatico, temtrazido inumeras duvidas sobre o papel da desnervacao autonomicana genese da cardiopatia chagasica. Apesar disso, desnervacao econsequente disfuncao autonomica provavelmente desempenhamum papel importante na genese dos fenomenos arritmicos e talvezda morte subita, muito prevalente em pacientes chagasicos
Endoscopic Transforaminal Discectomy for Recurrent Lumbar Disc Herniation: A Prospective, Cohort Evaluation of 262 Consecutive Cases

Study Design. A prospective, cohort evaluation of 262 consecutive patients who underwent transforaminal endoscopic excision for recurrent lumbar disc herniation, after previous discectomy. Objective. To review complications and results of the endoscopic transforaminal discectomy (ETD) for recurrent herniated disc with a 2-year follow-up. Summary of Background Data. Recurrent herniation is a significant problem, as scar formation and progressive disc degeneration may lead to increased morbidity after traditional posterior reoperation. The studies published until now on recurrent disc herniation concern various operative techniques, mostly the lumbar microdiscectomy, which is still seen as the standard. The advantage of ETD could be that there is no need to go through the old scar tissue and the procedure can be performed in local anesthesia. The disadvantage may be a long learning curve for the surgeon. Method. Between January 1994 and November 2002, 262 patients with primarily radicular problems underwent an ETD for a recurrent herniated disc. Two hundred and thirty-eight of these patients (90.84%) completed our 2-year follow-up questionnaire. Initial surgery of 82 patients was performed in-house, 180 external. Average age was 46.4 years. The female/male ratio was 29/71%. Results. At 2-year follow-up 85.71% of patients rated the result of the surgery as excellent or good. 9.66% reported a fair and 4.62% patients an unsatisfactory result. Average improvement of back pain of 5.71 points and 5.85 points of leg pain on the VAS scale (1–10). According to Mac Nab, 30.67% of the patients felt fully regenerated, 50% felt their functional capacity to be slightly restricted, 16.81% felt their functional capacity noticeably restricted, and 2.52% felt unimproved or worse. All patients participated in a 3-month follow-up to establish the perioperative complications. The overall complication rate was 10/262 (3.8%), including 3 nerve root irritations and 7 early recurrent herniations (<3 month). There was no case of infection or discitis. After 3 months and within 2 years, 4 patients have been treated for a recurrent herniated disc in our own center and 7 patients have been treated elsewhere, resulting in a recurrence rate 11/238 (4.62%). Conclusion. ETD for recurrent disc herniation seems to be an effective method with few complications and a high patient satisfaction.
Prognostic Value of Somatosensory-Evoked Potentials in the Surgical Management of Cervical Spondylotic Myelopathy

Study Design. Preoperative somatosensory-evoked potentials (SEPs) were retrospectively analyzed and classified, and compared with surgical outcome. Objective. To evaluate the value of the preoperative SEP waveform in predicting the clinical outcome after surgical management of cervical spondylotic myelopathy (CSM). Summary of Background Data. SEPs have played an important role in spinal surgery. However, the value of SEPs in predicting the outcome of surgery for CSM remains controversial. Methods. This study enrolled 76 CSM patients who underwent surgical intervention. Median nerve SEPs were recorded before surgery. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurologic function before surgery and at postoperative follow-up at 1, 3, 6, 12, and 24 months. Patients were divided into 5 groups according to the classification of their preoperative SEP waveforms. Group I patients had normal SEPs, group IIa had normal latency and abnormal amplitude, group IIb had abnormal latency and normal amplitude, group III had abnormal latency and amplitude, and group IV had immeasurable waveforms. The myelopathic disability scores and surgical outcomes in different groups were compared by the Kruskal-Wallis test. Results. The SEP classification was found to be significantly associated with the JOA score (Pearson’s &khgr;2 test, &khgr;2 = 53.9, P < 0.05). There were no significant differences in JOA score recovery at different follow-up times within any SEP group. At 24 months after surgery, there was no significant difference in the recovery ratio between groups I and IIa, or between groups IIb and III (Kruskal-Wallis test, P > 0.05). However, the recovery ratio was significantly higher in groups I and IIa than in all the other groups (Kruskal-Wallis test, P < 0.05), and in groups IIb and III than in group IV (Kruskal-Wallis test, P < 0.05). Conclusion. SEP classification correlates well with CSM disability and postoperative recovery ratio. Median nerve SEP recordings would be a valuable and practical tool for the diagnosis and prognosis of myelopathy.
Hepato‐splenic γδ T‐cell lymphoma: A rare entity mimicking the hemophagocytic syndrome

Hepatosplenic γδ T‐cell lymphoma is a rare histologic type of the peripheral T‐cell lymphomas, clinically characterized by predominant involvement of liver and spleen, no or little adenopathy, and an often aggressive course; it affects mainly adolescents and young adults, with a male predominance. Postthymic T‐cell malignancies are heterogeneous in their clinical and laboratory features. Among the γδ postthymic T‐cell lymphomas, two distinct entities (cutaneous and hepatosplenic, respectively) are reported in the literature. The former shows predominant multiple involvement of the skin and subcutaneous tissue; it occurs mostly in older patients and the phenotype is CD3−, CD4−, CD8−. Because of the small number of reports, the course of the disease was unknown. The latter shows a clinical picture characterized by hepatosplenomegaly, no or little adenopathy, and sometimes systemic symptoms (fever, cytopenias likely due to hypersplenism); it presents a peculiar sinusoidal involvement of liver and spleen. The bone marrow histologic feature often reveals a little infiltration, especially sinusoidal and easily underestimated phenotype: CD2+, CD3+, CD7+, CD5−, CD4−, CD8−, CD44+. Few cases of this lymphoma associated by hemophagocytic syndrome are described (Sun, 1990; Kadin, 1981; Jaffe, 1983). We report a case of a young man with a rapid and fatal course in which the more important clinical feature was hemophagocytosis. The diagnosis of lymphoma was very difficult because of paucity of histologic involvement, and only the rearrangement of TCR γ chain gene by polymerase chain reaction on paraffin sections confirmed a clonal T‐cell proliferation. Am. J. Hematol. 60:61–65, 1999. © 1999 Wiley‐Liss, Inc.
Diagnostic effectiveness of fine needle aspiration cytology on pediatric cervical lymphadenopathy

Purpose:There are few reports in Korean literature on the diagnostic efficacy of fine needle aspiration cytology(FNAC) for pediatric cervical lymphadenopathy. This study examined the diagnostic value of FNAC on cervical lymphadenopathy in children. Methods:Data from 57 pediatric patients(aged 0.3 to 14 years) who underwent FNAC due to cervical lymphadenopathy between January 2001 and March 2005 was reviewed retrospectively. Results:Reactive cervical lymphadenitis was the most common result of the FNAC(52.5 percent). Malignant disease were revealed in 14 percent of all cases. The sensitivity, specificity was 86 percent and 96 percent, respectively. The positive and negative predictive values for malignant disease was 75 percent and 98 percent, respectively. There were two false-positive cases on FNAC; one case of Langerhans cell histiocytosis, and another with infectious mononucleosis. A false-negative case on FNAC was found to be acute lymphocytic leukemia. In seven cases(12 percent), the final diagnosis was confirmed by an open biopsy after the FNAC. There were four FNAC cases where the specimen was not satisfactory for making a diagnosis(7 percent). There were no serious complications of the FNAC procedure. Conclusion:FNAC had a high diagnostic efficacy for evaluating children with cervical lymphadenopathy.
A Novel Operative Approach for the Treatment of Old Distractive Flexion Injuries of Subaxial Cervical Spine

Study Design. Retrospective study of 9 patients who underwent operations as treatments of old distractive flexion injuries (DFI, Stage 2 and 3) of subaxial cervical spine. Objective. Description of a novel operative sequence for reduction and stabilization of old DFI of subaxial cervical spine, and assessment of the clinical outcome. Summary of Background Data. Subaxial cervical spine injuries are often missed on the primary trauma survey. However, there is a relative paucity of published clinical data regarding the treatment of old DFI (≥3 weeks) of subaxial cervical spine. Our technique minimizes the total number of necessary procedures and differs in sequence from previously reported methods. Methods. Between January 2001 and January 2004, 9 patients with old DFI (Stage 2 and 3) of subaxial cervical spine underwent operative treatments and were followed-up for at least 2 years. A posterior procedure was conducted first, comprised of soft tissue release, facetectomy and interspinous wiring. Subsequent anterior procedure included soft tissue release, discectomy, reduction, intervertebral grafting, and anterior plating. One functional spinal unit was fused in this group. Neck pain, neurologic status, and radiographs were recorded throughout the patient’s course. Results. Intraoperative anatomic reduction was achieved by this technique in all patients. Neck pain significantly remitted after the operation and neurologic function improved. All involved segments maintained the anatomic reduction until bony fusion was achieved, with the exception of one case of DFI (Stage 3) at C6–C7 level, who lost partial reduction but achieved fusion ultimately. Conclusion. Using the posterior-anterior procedures, anatomic reduction was successfully achieved for old DFI of subaxial cervical spine, with decreased need to turn patients during operative interventions compared with previously reported techniques. Segmental stability was maintained till fusion, with the exception of one case of DFI at the C6–C7 level. Preliminary clinical outcomes were satisfying.
Education in the crucible of a postcolonial revolution: community reaction to the challenges of Zimbabwe’s crisis

It is paradoxical that when Zimbabwe was experiencing the worst economic situation in its recorded history and the highest inflation rate ever experienced worldwide by any nation at peace, its educational achievements were unprecedented. The economy had untold negative effects on the education system causing mass exodus of teachers, dilapidation of infrastructure, shortage of library books and even lack of food. However, against this backdrop, the country scored major successes in education. In 2010, Zimbabwe became the highest ranked in terms of literacy on the continent. University enrolment was ninefold by 2006, and technical and vocational education has achieved similar developments. How and by what means? Research on education has so far mainly focused on the institutions of higher learning with little or no concern at all about community activities and efforts to sustain education at various levels. In fact until recently university education in Zimbabwe has had little community participation. This had to change during the last decade when the state could not afford to fund its own army, let alone education. Donor, bilateral and multilateral funding were withdrawn as the sanctions screw tightened. This research explores the community (students and parents) efforts in sustaining education from secondary to tertiary institutions. How did parents and students react to the deteriorating conditions of education and with what effect? The study findings indicate parents responded by supporting teachers with money and food, engaging in economic activities such as cross-border trading, and were involved in teaching the students. The students also responded by engaging in peer education and sharing resources such as books. This study could widen our understanding of community participation in education particularly at university level.
Exercise Therapy and Low Back Pain: Insights and Proposals to Improve the Design, Conduct, and Reporting of Clinical Trials

Study Design. A report on plenary presentations and discussions of an expert panel and workshop (“Exercise as a treatment for subacute low back pain”) that was held at the Amsterdam Forum VIII on Low Back Pain Research in Primary Care. Objective. To highlight important issues regarding the design, conduct, and reporting of exercise trials and to provide suggestions for improvement in each domain. Summary of Background Data. Despite improvements in the methodologic quality of randomized clinical trials on low back pain (LBP), current trials on exercise therapy still show methodologic flaws in the design and reporting of studies. Methods. Important issues in the design, conduct, and reporting of exercise trials for LBP were introduced by 4 presenters, and this was followed by a group discussion among 40 attendees. Conclusions and recommendations were extracted by the workshop panelists and summarized in this paper. Results. Workshop discussion led to the following recommendations: (1) specify a theoretical framework for exercise therapy for designing the intervention and selecting appropriate treatment efficacy measures; (2) to overcome blinding problems in exercise trials, include sham interventions and assess the success of blinding; (3) evaluate the role of patient-provider interactions through the use of self-report or observational measures; (4) to assure quality of treatment, use exercise interventions that reference existing exercise guidelines; (5) use subgroup analyses to identify subgroups of patients most likely to benefit; (6) in reporting exercise trials, include an extensive description of the study population, a detailed exercise protocol, and some measure of patient compliance; (7) further categorization of exercise interventions is needed, in terms of concept, mode, intensity, duration, frequency, and length; and (8) trial;1>registration and publication of detailed study protocols may help to strengthen the evidence-based concerning exercise therapy for LBP. Conclusion. By paying proper attention to issues concerning the design and reporting of exercise protocols when conducting future exercise trials, research may provide a stronger evidence basis for recommending or not recommending various exercise therapies for LBP.
The Extent of Fusion Within the Congenital Klippel-Feil Segment

Study Design. Retrospective radiographic review. Objective. To evaluate in patients with Klippel-Feil syndrome (KFS) the presence and extent of specific fusion patterns across involved cervical segments and their association with age-specific parameters. Summary of Background Data. While the radiographic hallmark of KFS is characterized by congenital fusion of at least one cervical motion segment, the relation between age and the extent of segmental congenital fusion remains speculative. Methods. A radiographic review of 31 patients with KFS at a single institution. Plain radiographs were used to assess fusion across the vertebral segment as entailing the anterior elements, posterior elements, or complete segment from O–T1. Age-specific stratifications were also performed. Results. A mean of 3.7 fused segments and a sum of 116 fused segments were noted. From C2–T1, complete fusion of the involved segment represented 77.8% at 10 years or older, 87.5% at 15 years or older, 91.7% at 16 years or older, 95.7% at 17 years or older, 86.5% who were skeletally mature, and 100% at adulthood. Similar trends were not noted for segments of O–C2. In absence of complete segmental fusion, the posterior elements exhibited a higher incidence of fusion than the anterior elements. Statistically significant differences between anterior/posterior to complete segmental fusion with respect to different age markers entailed segments of C2–C3, C4–C5, and C6–C7 (P < 0.05). Conclusion. This study provides some insight into the potential developmental aspects of the extent of segmental fusion of the cervical spine in patients with KFS. In older patients, complete fusion of involved fused segments was more prevalent in regards to C2–T1; however, such an observation was not noted for segments from O–C2. In the absence of complete segmental fusion, fusion of the posterior elements was more often noted than fusion of the anterior elements. Awareness of the varied phenotypic expression of segmental fusion patterns of the cervical spine in patients with KFS underlines theimportance of thorough evaluation of the cervical spine to assess the presence and extent of segmental fusion to facilitate in the identification of neurologic risk factors.
Comparison of gonadotropin‐releasing hormone agonists and antagonists in assisted reproduction cycles of polycystic ovarian syndrome patients

Aim: Gonadotropin‐releasing hormone (GnRH) antagonists have reduced the incidence of severe ovarian hyper stimulation syndrome (OHSS) and rate of hospitalization due to severe OHSS, especially in polycystic ovarian syndrome (PCOS) patients. The present study aimed to compare the outcomes of patients with PCOS undergoing controlled ovarian hyperstimulation (COH) with GnRH agonist versus GnRH antagonist protocols for assisted reproduction cycles.
Relation Between Changes in Posteroanterior Stiffness and Active Range of Movement of the Cervical Spine Following Manual Therapy Treatment

Study Design. Repeated measures study of active and passive movements in patients with neck pain. Objectives. To determine if, following manual therapy: (1) changes occur in active range of movement (AROM) and stiffness of posteroanterior (PA) movements, (2) such changes are dependent on the location treated, and (3) there is a relation between changes in PA stiffness and AROM. Summary of Background Data. PA movements are frequently used to assess patients with neck pain but little is known about how these movements are related to patient symptoms. Methods. One location deemed symptomatic and hypomobile and 1 asymptomatic location were selected in 20 patients with neck pain for more than 2 weeks. PA stiffness at each location and AROM were measured before and after each of 4 manual therapy interventions: PA movements to each location, a general treatment, and a control intervention. Results. The general intervention had a greater increase in each axis of AROM than the other interventions (F = 2.814 to 7.929, DF = 3) but there were no differences in PA stiffness across interventions (F = 0.945, DF = 3). Differences in PA stiffness was divided into regions by applied force. After treatment to the symptomatic location, regions of stiffness at forces above 8 N demonstrated significant correlations with total AROM (R = −0.466 to −0.628). Conclusion. After manual therapy, increased AROM is related to decreased PA stiffness in patients with neck pain, but only for the treated location and only when that location had been identified previously as symptomatic and hypomobile.