Miracle-dz/UniFAR-FTUs huggingface dataset:
Squamous cell carcinoma of the bulbar urethra.

Case Report A 49-year-old man with a history of balanitis xerotica obliterans and meatal stricture treated with circumcision and meatoplasty 4 years before presented with a recurrent urinary tract infection. Urethroscopy revealed a lesion in the bulbar urethra, which was confirmed to be a squamous cell carcinoma (SCC) with histology. Magnetic resonance imaging (MRI) confirmed a bulky tumor that emanated from the bulb of the penis, abutted the anorectal junction, and extended to involve the corpora cavernosa, the urogenital diaphragm, the apex of the prostate, and the levator ani. [F]fluorodeoxyglucose positron emission tomography (PET) showed an avid primary lesion with biliateral inguinal lymph node avidity. The multidisciplinary consensus was treatment with radical chemoradiotherapy to obtain local control and treat potential micrometastatic disease followed by radical surgery with curative intent and to gain local control if restaging imaging showed no metastatic disease. The patient received six cycles of cisplatin and 60 Gy of radiotherapy in 30 fractions over 38 days. Restaging MRI 6 weeks after completion of chemoradiotherapy showed a decrease in size of the tumor with central necrosis and a new lesion in the distal penis. PET showed a partial metabolic response in the primary tumor (Figs 1A, PET at diagnosis and 1B, 6 weeks after chemoradiotherapy), persisting mild uptake in a single inguinal node, and new mild uptake in an external iliac node, which was thought to be reactive and was subsequently confirmed by using fine-needle aspiration. Because of the good response to chemoradiotherapy, the consensus was to repeat imaging in 6 weeks to assess a possible ongoing response to chemoradiotherapy before radical surgery. Six weeks later, PET showed interval progression (Figs 2A, PET 6 weeks after chemoradiotherapy and 2B, 12 weeks after chemoradiotherapy), with more intense uptake in the primary tumor, that extended down the penile shaft and was confluent with the distal penile lesion previously seen by using MRI with increased avidity in the inguinal node. MRI showed local extension of the primary tumor, which abutted the anterior rectal wall and infiltrated through the levator ani into the perineum. Because of the rapid local progression of disease, increasing pelvic pain, and absence of distal metastases, a radical en bloc resection was performed, which required abdominoperineal resection, right inguinal superficial lymphadenectomy, cystoprostatectomy with ileal conduit, penectomy, scrotal excision, and bilateral orchidectomy (Fig 3). The
Body Size Perceptions and Preferences of Older African-American Women

Abstract This study examined body mass index, body size perceptions via silhouettes, and dietary knowledge and behaviors among 101 older African-American women. BMI was highly correlated with body size silhouette choice. Women who perceived themselves to be overweight reported significantly less dairy consumption (p = .02). Women with greater nutrition knowledge consumed fruit more frequently (p = .05) and consumed chips/french fries less frequently (p = .002) in the previous 24-hour recall. Perceptions of being overweight were associated with BMI and weight change behavior.
Ovarian Toxicity of 2‐Bromopropane in the Non‐Pregnant Female Rat

Ovarian Toxicity of 2‐Bromopropane in the Non‐Pregnant Female Rat: Michihiro Kamijima, et al. Department of Hygiene, Nagoya University School of Medicine—A cluster of patients with amenorrhea, oligospermia and anemia were found among workers in an electronics factory in the Republic of Korea. 2‐Bromopropane was suspected to cause the disorders. This study aimed to clarify its ovarian toxicity in the virgin rat. Female Wistar rats were daily exposed to 0, 100, 300, or 1,000 ppm 2‐bromopropane for eight hours a day for 9 weeks. During the experimental period, vaginal smears were taken everyday to monitor ovarian cyclicity. Tissues were histopathologically examined and plasma concentrations of luteinizing hormone (LH) and follicle‐stimulating hormone (FSH) were determined at the end of experiment. The vaginal smear test showed that the number of normal cycles decreased significantly both in the 300 and 1,000 ppm groups. The histopathological examination revealed dose‐dependent ovarian follicle atresia accompanied by a decreased number of normal antral and growing follicles in the 300 and 1,000 ppm groups. Especially, in the ovaries of rats with persistent estrous smears in the 1,000 ppm group, most of the follicles were atretic and there were no newly formed corpora lutea. There still remained normal antral follicles and corpora lutea in the ovaries of the remaining rats of the group and of the 300 ppm group with constant diestrous and occasional estrous smears. Hormonal examination revealed no statistically significant change in LH or FSH concentrations between any groups. The results showed that 2‐bromopropane has ovarian toxicity in rats, indicating that the secondary amenorrhea in human cases was due to 2‐bromopropane exposure.
Predicting the population impact of chlamydia screening programmes: comparative mathematical modelling study

Background: Published individual-based, dynamic sexual network modelling studies reach different conclusions about the population impact of screening for Chlamydia trachomatis. The objective of this study was to conduct a direct comparison of the effect of organised chlamydia screening in different models. Methods: Three models simulating population-level sexual behaviour, chlamydia transmission, screening and partner notification were used. Parameters describing a hypothetical annual opportunistic screening program in 16–24 year olds were standardised, whereas other parameters from the three original studies were retained. Model predictions of the change in chlamydia prevalence were compared under a range of scenarios. Results: Initial overall chlamydia prevalence rates were similar in women but not men and there were age and sex-specific differences between models. The number of screening tests carried out was comparable in all models but there were large differences in the predicted impact of screening. After 10 years of screening, the predicted reduction in chlamydia prevalence in women aged 16–44 years ranged from 4% to 85%. Screening men and women had a greater impact than screening women alone in all models. There were marked differences between models in assumptions about treatment seeking and sexual behaviour before the start of the screening intervention. Conclusions: Future models of chlamydia transmission should be fitted to both incidence and prevalence data. This meta-modelling study provides essential information for explaining differences between published studies and increasing the utility of individual-based chlamydia transmission models for policy making.
Phase II, open-label, randomized, multicenter study comparing the efficacy and safety of olaparib, a poly (ADP-ribose) polymerase inhibitor, and pegylated liposomal doxorubicin in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer.

PURPOSE Olaparib (AZD2281), an orally active poly (ADP-ribose) polymerase inhibitor that induces synthetic lethality in BRCA1- or BRCA2-deficient cells, has shown promising clinical efficacy in nonrandomized phase II trials in patients with ovarian cancer with BRCA1 or BRCA2 deficiency. We assessed the comparative efficacy and safety of olaparib and pegylated liposomal doxorubicin (PLD) in this patient population. PATIENTS AND METHODS In this multicenter, open-label, randomized, phase II study, patients with ovarian cancer that recurred within 12 months of prior platinum therapy and with confirmed germline BRCA1 or BRCA2 mutations were enrolled. Patients were assigned in a 1:1:1 ratio to olaparib 200 mg twice per day or 400 mg twice per day continuously or PLD 50 mg/m(2) intravenously every 28 days. The primary efficacy end point was Response Evaluation Criteria in Solid Tumors (RECIST) -assessed progression-free survival (PFS). Secondary end points included objective response rate (ORR) and safety. RESULTS Ninety-seven patients were randomly assigned. Median PFS was 6.5 months (95% CI, 5.5 to 10.1 months), 8.8 months (95% CI, 5.4 to 9.2 months), and 7.1 months (95% CI, 3.7 to 10.7 months) for the olaparib 200 mg, olaparib 400 mg, and PLD groups, respectively. There was no statistically significant difference in PFS (hazard ratio, 0.88; 95% CI, 0.51 to 1.56; P = .66) for combined olaparib doses versus PLD. RECIST-assessed ORRs were 25%, 31%, and 18% for olaparib 200 mg, olaparib 400 mg, and PLD, respectively; differences were not statistically significant. Tolerability of both treatments was as expected based on previous trials. CONCLUSION The efficacy of olaparib was consistent with previous studies. However, the efficacy of PLD was greater than expected. Olaparib 400 mg twice per day is a suitable dose to explore in further studies in this patient population.
Randomized phase III study comparing paclitaxel-bleomycin, etoposide, and cisplatin (BEP) to standard BEP in intermediate-prognosis germ-cell cancer: intergroup study EORTC 30983.

PURPOSE To compare the efficacy of four cycles of paclitaxel-bleomycin, etoposide, and cisplatin (T-BEP) to four cycles of bleomycin, etoposide, and cisplatin (BEP) in previously untreated patients with intermediate-prognosis germ-cell cancer (GCC). PATIENTS AND METHODS Patients were randomly assigned to receive either T-BEP or standard BEP. Patients assigned to the T-BEP group received paclitaxel 175 mg/m(2) in a 3-hour infusion. Patients who were administered T-BEP received primary granulocyte colony-stimulating factor (G-CSF) prophylaxis. The study was designed as a randomized open-label phase II/III study. To show a 10% improvement in 3-year progression-free survival (PFS), the study aimed to recruit 498 patients but closed with 337 patients as a result of slow accrual. RESULTS Accrual was from November 1998 to April 2009. A total of 169 patients were administered BEP, and 168 patients were administered T-BEP. Thirteen patients in both arms were ineligible, mainly as a result of a good prognosis of GCC (eight patients administered BEP; six patients administered T-BEP) or a poor prognosis of GCC (one patient administered BEP; four patients administered T-BEP). PFS at 3 years (intent to treat) was 79.4% in the T-BEP group versus 71.1% in the BEP group (hazard ratio [HR], 0.73; CI, 0.47 to 1.13; P [log-rank test] = 0.153). PFS at 3 years in all eligible patients was 82.7% versus 70.1%, respectively (HR, 0.60; CI: 0.37 to 0.97) and was statistically significant (P = 0.03). Overall survival was not statistically different. CONCLUSION T-BEP administered with G-CSF seems to be a safe and effective treatment regimen for patients with intermediate-prognosis GCC. However, the study recruited a smaller-than-planned number of patients and included 7.7% ineligible patients. The primary analysis of the trial could not demonstrate statistical superiority of T-BEP for PFS. When ineligible patients were excluded, the analysis of all eligible patients demonstrated a 12% superior 3-year PFS with T-BEP, which was statistically significant.
Epidemiology of injuries in gymnastics

A prospective one‐year epidemiological study was carried out to determine the injury incidence and the injury mechanisms in different groups of gymnasts and to identify possible risk factors. A total of 115 gymnasts with a median age of 16 (8‐25) were followed through a whole season of median 48 weeks (ranges 40–51). The overall injury incidence was 85 per 100 gymnasts per season, ranging from 27 in subelite males to 157 in subelite females. This high incidence is partly explained by the use of a sensitive injury definition, the high exposure time, and the large proportion of highly competitive gymnasts in the population. Considering the exposure time, however, the incidence is lower than in most other sports, 1.6 per 1000 h of gymnastic activity. Subelite female gymnasts were more commonly injured than other artistic gymnasts, in particular in relation to balance beam exercises and inadequate spotting. Injuries were predominantly localized to the lower extremities (64%) for the whole population of gymnasts. A siwcantly large proportion of the male artistic gymnasts, nevertheless, sustained upper extremity injuries corresponding to their apparatus performance. Most injuries were of mild or moderate severity, the recovery time was, however, considerable (median 30 days, ranges 1–365), and the injuries sustained during competition had a median recovery period of 180 days (7‐270). Twenty‐two per cent of the injuries resulted in a recovery period of more than 6 months. Re‐evaluation of the criteria of the score system for dismount as well as an increased use of spotters during practice and high‐risk events are possible measures to prevent serious injuries.
Superiority of the triple combination of bortezomib-thalidomide-dexamethasone over the dual combination of thalidomide-dexamethasone in patients with multiple myeloma progressing or relapsing after autologous transplantation: the MMVAR/IFM 2005-04 Randomized Phase III Trial from the Chronic Leukemia

PURPOSE This prospective multicenter phase III study compared the efficacy and safety of a triple combination (bortezomib-thalidomide-dexamethasone [VTD]) versus a dual combination (thalidomide-dexamethasone [TD]) in patients with multiple myeloma (MM) progressing or relapsing after autologous stem-cell transplantation (ASCT). PATIENTS AND METHODS Overall, 269 patients were randomly assigned to receive bortezomib (1.3 mg/m(2) intravenous bolus) or no bortezomib for 1 year, in combination with thalidomide (200 mg per day orally) and dexamethasone (40 mg orally once a day on 4 days once every 3 weeks). Bortezomib was administered on days 1, 4, 8, and 11 with a 10-day rest period (day 12 to day 21) for eight cycles (6 months), and then on days 1, 8, 15, and 22 with a 20-day rest period (day 23 to day 42) for four cycles (6 months). RESULTS Median time to progression (primary end point) was significantly longer with VTD than TD (19.5 v13.8 months; hazard ratio, 0.59; 95% CI, 0.44 to 0.80; P = .001), the complete response plus near-complete response rate was higher (45% v 21%; P 0.001), and the median duration of response was longer (17.9 v 13.4 months; P.04) [corrected]. The 24-month survival rate was in favor of VTD (71% v 65%; P = .093). Grade 3 peripheral neuropathy was more frequent with VTD (29% v 12%; P = .001) as were the rates of grades 3 and 4 infection and thrombocytopenia. CONCLUSION VTD was more effective than TD in the treatment of patients with MM with progressive or relapsing disease post-ASCT but was associated with a higher incidence of grade 3 neurotoxicity.
A 6.3 µW 20 bit Incremental Zoom-ADC with 6 ppm INL and 1 µV Offset

A 20-bit incremental ADC for battery-powered sensor applications is presented. It is based on an energy-efficient zoom ADC architecture, which employs a coarse 6-bit SAR conversion followed by a fine 15-bit ΔΣ conversion. To further improve its energy efficiency, the ADC employs integrators based on cascoded dynamic inverters for extra gain and PVT tolerance. Dynamic error correction techniques such as auto-zeroing, chopping and dynamic element matching are used to achieve both low offset and high linearity. Measurements show that the ADC achieves 20-bit resolution, 6 ppm INL and 1 μV offset in a conversion time of 40 ms, while drawing only 3.5 μA current from a 1.8 V supply. This corresponds to a state-of-the-art figure-of-merit (FoM) of 182.7 dB. The 0.35 mm2 chip was fabricated in a standard 0.16 μm CMOS process.
Continuing medical education in Saudi Arabia: Experiences and perception of participants

Introduction: Continuing medical education (CME) is important in developing competencies of medical practitioners with all the different influencing factors that have impact on their opinions and preferences. Despite the broad range of work on CME, very few studies have examined participants' opinions and attitudes towards CME. However, understanding them is critical in improving the practice of CME. Purpose: The purpose of this study was to explore attendees' perception of CME in Saudi Arabia regarding the different aspects of its practices and preferences. Materials and Methods: A survey composed of demographic questions, frequency of reading habits and 24 other related items was developed for CME participants. Participants were asked to indicate the extent to which they agreed or disagreed with each of the 24 items on a 5-point Likert scale. In total, 601 surveys were analysed. Results: The response to each item in the questionnaire was compared on the basis of demographic variables. The results showed that healthcare practitioners acknowledged the importance of CME in improving their knowledge, attitudes, clinical and academic skills, as well as improve their clinical practice outcome. Differences of opinion were categorised by gender, profession, nationality and age. Conclusion: The study showed that opinions related to CME varied among different disciplines and nationalities. Moreover, it raised questions related to the system of sponsoring participants to attend CME events and its consideration for ethical issues. There is a need to embed the concept of lifelong learning into the education of basic health professions. In addition, the policies related to sponsoring and accrediting CME in Saudi Arabia should be improved. We recommend further research into this matter.
European Treatment and Outcome Study (EUTOS) score for chronic myeloid leukemia still requires more confirmation.

TO THEEDITOR: In 1984, Sokal et al 1 developed a scoring system to predict the outcome of patients with chronic myeloid leukemia (CML). The scoring system rapidly gained popularity and has re- mained until now the most widely accepted method for assessing prognosis for patients with CML. Although the Sokal score was devel- oped for patients with nonblastic disease who were treated with hy- droxyurea or busulfan, it also proved useful for predicting the survival of patients treated with interferon 2 and can predict the outcome for patients treated with imatinib. 3,4 Interestingly, it also predicts the outcome for patients who receive imatinib after experiencing treat- ment failure with interferon 5 and for patients who receive second- generation tyrosine kinase inhibitors after experiencing treatment failure with imatinib. 6 The consistent value of the Sokal scoring system in different clinical situations suggests that it measures, at least in part, factors that are intrinsic in leukemia and does not merely reflect the point in its evolution at which the leukemia is diagnosed. The Sokal index is a numerical value that is calculated at diagnosis from the percentage of blast cells in peripheral blood, the platelet count, the spleen size (measured in centimeters below the costal mar- gin), and the age of the patient. 1 Patients are divided into three risk groups: low, intermediate, and high, according to their individual numerical value. Recently, the European Leukemia-Net has devel- oped a new scoring system (European Treatment and Outcome Study (EUTOS) score) using data from 2,060 patients who were treated with imatinib-based regimens. The EUTOS score is similar to the Sokal score, and patients are classified as a high or low risk on the basis of the percentage of basophils in the peripheral blood and the spleen size at diagnosis. 7 It has been suggested that the EUTOS score has superior prognostic power when compared with the Sokal score. 7 Here we explore the prognostic value of the new EUTOS score as applied to an independent cohort of patients. Two hundred eighty-two consecutive patients with CML in
Double-blind, randomized trial of docetaxel plus vandetanib versus docetaxel plus placebo in platinum-pretreated metastatic urothelial cancer.

PURPOSE Vandetanib is an oral once-daily tyrosine kinase inhibitor with activity against vascular endothelial growth factor receptor 2 and epidermal growth factor receptor. Vandetanib in combination with docetaxel was assessed in patients with advanced urothelial cancer (UC) who progressed on prior platinum-based chemotherapy. PATIENTS AND METHODS The primary objective was to determine whether vandetanib 100 mg plus docetaxel 75 mg/m(2) intravenously every 21 days prolonged progression-free survival (PFS) versus placebo plus docetaxel. The study was designed to detect a 60% improvement in median PFS with 80% power and one-sided α at 5%. Patients receiving docetaxel plus placebo had the option to cross over to single-agent vandetanib at progression. Overall survival (OS), overall response rate (ORR), and safety were secondary objectives. RESULTS In all, 142 patients were randomly assigned and received at least one dose of therapy. Median PFS was 2.56 months for the docetaxel plus vandetanib arm versus 1.58 months for the docetaxel plus placebo arm, and the hazard ratio for PFS was 1.02 (95% CI, 0.69 to 1.49; P = .9). ORR and OS were not different between both arms. Grade 3 or higher toxicities were more commonly seen in the docetaxel plus vandetanib arm and included rash/photosensitivity (11% v 0%) and diarrhea (7% v 0%). Among 37 patients who crossed over to single-agent vandetanib, ORR was 3% and OS was 5.2 months. CONCLUSION In this platinum-pretreated population of advanced UC, the addition of vandetanib to docetaxel did not result in a significant improvement in PFS, ORR, or OS. The toxicity of vandetanib plus docetaxel was greater than that for vendetanib plus placebo. Single-agent vandetanib activity was minimal.
Accumulation of Multipotent Progenitor Cells on Polymethylpentene Membranes During Extracorporeal Membrane Oxygenation.

Multipotent progenitor cells were mobilized during pediatric extracorporeal membrane oxygenation (ECMO). We hypothesize that these cells also adhered onto polymethylpentene (PMP) fibers within the membrane oxygenator (MO) during adult ECMO support. Mononuclear cells were removed from the surface of explanted PMP-MOs (n = 16). Endothelial-like outgrowth and mesenchymal-like cells were characterized by flow cytometric analysis using different surface markers. Spindle-shaped attaching cells were identified early, but without proliferative activity. After long-term cultivation palisading type or cobblestone-type outgrowth cells with high proliferative activity appeared and were characterized as (i) leukocytoid CD45+/CD31+ (CD133+/VEGFR-II+/CD90+/CD14+/CD146dim/CD105dim); (ii) endothelial-like CD45-/CD31+ (VEGF-RII+/CD146+/CD105+/CD133-/CD14-/CD90-); and (iii) mesenchymal-like cells CD45-/CD31- (CD105+/CD90+/CD133dim/VEGFR-II-/CD146-/CD14-). The distribution of the cell populations depended on the MO and cultivation time. Endothelial-like cells formed capillary-like structures and did uptake Dil-acetylated low-density lipoprotein. Endothelial- and mesenchymal-like cells adhered on the surface of PMP-MOs. Further research is needed to identify the clinical relevance of these cells.