Miracle-dz/UniFAR-FTUs huggingface dataset:
Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

Importance Cohort studies, mainly based on questionnaires and interviews, have reported high rates of reflux recurrence after antireflux surgery, which may have contributed to a decline in its use. Reflux recurrence after laparoscopic antireflux surgery has not been assessed in a long-term population-based study of unselected patients. Objectives To determine the risk of reflux recurrence after laparoscopic antireflux surgery and to identify risk factors for recurrence. Design and Setting Nationwide population-based retrospective cohort study in Sweden between January 1, 2005, and December 31, 2014, based on all Swedish health care and including 2655 patients who underwent laparoscopic antireflux surgery according to the Swedish Patient Registry. Their records were linked to the Swedish Causes of Death Registry and Prescribed Drug Registry. Exposures Primary laparoscopic antireflux surgery due to gastroesophageal reflux disease in adults (>18 years). Main Outcomes and Measures The outcome was recurrence of reflux, defined as use of antireflux medication (proton pump inhibitors or histamine2 receptor antagonists for >6 months) or secondary antireflux surgery. Multivariable Cox regression was used to assess risk factors for reflux recurrence. Results Among all 2655 patients who underwent antireflux surgery (median age, 51.0 years; interquartile range, 40.0-61.0 years; 1354 men [51.0%]) and were followed up for a median of 5.6 years, 470 patients (17.7%) had reflux recurrence; 393 (83.6%) received long-term antireflux medication and 77 (16.4%) underwent secondary antireflux surgery. Risk factors for reflux recurrence included female sex (hazard ratio [HR], 1.57 [95% CI, 1.29-1.90]; 286 of 1301 women [22.0%] and 184 of 1354 men [13.6%] had recurrence of reflux), older age (HR, 1.41 [95% CI, 1.10-1.81] for age ≥61 years compared with ⩽45 years; recurrence among 156 of 715 patients and 133 of 989 patients, respectively), and comorbidity (HR, 1.36 [95% CI, 1.13-1.65] for Charlson comorbidity index score ≥1 compared with 0; recurrence among 180 of 804 patients and 290 of 1851 patients, respectively). Hospital volume of antireflux surgery was not associated with risk of reflux recurrence (HR, 1.09 [95% CI, 0.77-1.53] for hospital volume ⩽24 surgeries compared with ≥76 surgeries; recurrence among 38 of 266 patients [14.3%] and 271 of 1526 patients [17.8%], respectively). Conclusions and Relevance Among patients who underwent primary laparoscopic antireflux surgery, 17.7% experienced recurrent gastroesophageal reflux requiring long-term medication use or secondary antireflux surgery. Risk factors for recurrence were older age, female sex, and comorbidity. Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring treatment, diminishing some of the benefits of the operation.
Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions

Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions Inappropriate antibiotic prescribing contributes to antibiotic resistance and leads to adverse events.1 A clusterrandomized trial of 3 behavioral interventions2 intended to reduce inappropriate prescribing found that 2 of the 3 interventions were effective.3 This study examines the persistence of effects 12 months after stopping the interventions.
Correlación entre perfil psicomotor y rendimiento lógico-matemático en niños de 4 a 8 años

Objective: to determine the correlation between the psychomotor profile and mathematicalperformance in children between 4 and 8 years. Materials and methods: Cross-sectional studyin 389 in male and female students of 8 public educational institutions of the Barranquilla cityand Puerto Colombia municipality. Psychomotor Profile was evaluated through Vitor Da Fonsecabattery and logical mathematical performance by grade point average during the period ofthe measurement. We calculated the arithmetic mean, standard deviation and proportions, and Pearson correlation coefficient. Results: The mean age was 5,5 ±1,2 years. 60% were female.We found a correlation between psychomotor profile and logical mathematical performanceof 0,12 (p=0,01). Conclusions: there is a direct correlation between the psychomotor profileand logical mathematical performance.
Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial

Importance Hypoxia is common in the first few days after acute stroke, is frequently intermittent, and is often undetected. Oxygen supplementation could prevent hypoxia and secondary neurological deterioration and thus has the potential to improve recovery. Objective To assess whether routine prophylactic low-dose oxygen therapy was more effective than control oxygen administration in reducing death and disability at 90 days, and if so, whether oxygen given at night only, when hypoxia is most frequent, and oxygen administration is least likely to interfere with rehabilitation, was more effective than continuous supplementation. Design, Setting, and Participants In this single-blind randomized clinical trial, 8003 adults with acute stroke were enrolled from 136 participating centers in the United Kingdom within 24 hours of hospital admission if they had no clear indications for or contraindications to oxygen treatment (first patient enrolled April 24, 2008; last follow-up January 27, 2015). Interventions Participants were randomized 1:1:1 to continuous oxygen for 72 hours (n = 2668), nocturnal oxygen (21:00 to 07:00 hours) for 3 nights (n = 2667), or control (oxygen only if clinically indicated; n = 2668). Oxygen was given via nasal tubes at 3 L/min if baseline oxygen saturation was 93% or less and at 2 L/min if oxygen saturation was greater than 93%. Main Outcomes and Measures The primary outcome was reported using the modified Rankin Scale score (disability range, 0 [no symptoms] to 6 [death]; minimum clinically important difference, 1 point), assessed at 90 days by postal questionnaire (participant aware, assessor blinded). The modified Rankin Scale score was analyzed by ordinal logistic regression, which yields a common odds ratio (OR) for a change from one disability level to the next better (lower) level; OR greater than 1.00 indicates improvement. Results A total of 8003 patients (4398 (55%) men; mean [SD] age, 72 [13] years; median National Institutes of Health Stroke Scale score, 5; mean baseline oxygen saturation, 96.6%) were enrolled. The primary outcome was available for 7677 (96%) participants. The unadjusted OR for a better outcome (calculated via ordinal logistic regression) was 0.97 (95% CI, 0.89 to 1.05; P = .47) for oxygen vs control, and the OR was 1.03 (95% CI, 0.93 to 1.13; P = .61) for continuous vs nocturnal oxygen. No subgroup could be identified that benefited from oxygen. At least 1 serious adverse event occurred in 348 (13.0%) participants in the continuous oxygen group, 294 (11.0%) in the nocturnal group, and 322 (12.1%) in the control group. No significant harms were identified. Conclusions and Relevance Among nonhypoxic patients with acute stroke, the prophylactic use of low-dose oxygen supplementation did not reduce death or disability at 3 months. These findings do not support low-dose oxygen in this setting. Trial Registration ISRCTN Identifier: ISRCTN52416964
The Effects of Graded Levels of Calorie Restriction: X. Transcriptomic Responses of Epididymal Adipose Tissue

Abstract Calorie restriction (CR) leads to a remarkable decrease in adipose tissue mass and increases longevity in many taxa. Since the discovery of leptin, the secretory abilities of adipose tissue have gained prominence in the responses to CR. We quantified transcripts of epididymal white adipose tissue of male C57BL/6 mice exposed to graded levels of CR (0–40% CR) for 3 months. The numbers of differentially expressed genes (DEGs) involved in NF-κB, HIF1-α, and p53 signaling increased with increasing levels of CR. These pathways were all significantly downregulated at 40% CR relative to 12 h ad libitum feeding. In addition, graded CR had a substantial impact on DEGs associated with pathways involved in angiogenesis. Of the 497 genes differentially expressed with graded CR, 155 of these genes included a signal peptide motif. These putative signaling proteins were involved in the response to ketones, TGF-β signaling, negative regulation of insulin secretion, and inflammation. This accords with the previously established effects of graded CR on glucose homeostasis in the same mice. Overall these data suggest reduced levels of adipose tissue under CR may contribute to the protective impact of CR in multiple ways linked to changes in a large population of secreted proteins.
Cost of treatment in patients with metastatic soft tissue sarcoma who respond favourably to chemotherpy. The SArcoma treatment and Burden of Illness in North America and Europe (SABINE) study.

Treatment of metastatic soft tissue sarcoma (mSTS) commonly includes multiple lines of chemotherapy, until a decline in performance status precludes further treatment. The primary objective of this study was to describe the lifetime healthcare resource utilisation and cost among mSTS patients with favourable response to chemotherapy. SABINE was a multi-centre (n = 25), multi-country (n = 9) retrospective chart review study of mSTS patients with favourable response to chemotherapy following 4 cycles. Healthcare resource utilisation was collected from first line until death or end of follow-up. Costs were analysed by health states (defined by treatment line, chemotherapy use and disease progression) and estimated by multiplying the mean weekly cost per health state by the expected number of weeks spent in each health state. Expected per-patient lifetime medical cost was €65 616 (95% CI: €51 454-€85 003); comprised of IV chemotherapy (31.7%), inpatient care (24.8%), concomitant medication (11.0%), oral chemotherapy (8.9%), outpatient visits (8.8%), radiotherapy (6.3%), hospice (4.0%), imaging (3.7%) and laboratory (0.7%). Weekly costs were 280-330% higher during chemotherapy treatment periods than off-chemotherapy, especially after disease progression. Per-patient costs were highest in the USA and lowest in the Netherlands and UK. The economic burden of mSTS is considerable and the amount of resources devoted to its treatment varies across countries.
Plasma Klotho and Frailty in Older Adults: Findings From the InCHIANTI Study.

BACKGROUND The hormone klotho, encoded by the gene klotho, is primarily expressed in the kidney and choroid plexus of the brain. Higher klotho concentrations have been linked to better physical performance; however, it is unknown whether klotho relates to frailty status in older adults. METHODS Plasma klotho was measured in 774 participants aged ≥65 years enrolled in InCHIANTI, a prospective cohort study comprising Italian adults. Frailty status was assessed at 3 and 6 years after enrollment. Frailty was defined as presence of at least three out of five criteria of unintentional weight loss, exhaustion, sedentariness, muscle weakness, and slow walking speed; prefrailty was defined as presence of one or two criteria; and robustness was defined as zero criteria. We assessed whether plasma klotho concentrations measured at the 3-year visit related to frailty. RESULTS Each additional natural logarithm of klotho (pg/mL) was associated with lower odds of frailty versus robustness after adjustment for covariates (odds ratio [OR] 0.46; 95% confidence interval 0.21, 0.98; p-value = .045). Higher klotho was particularly associated with lower odds of exhaustion (OR 0.57; 95% CI 0.36, 0.89; p-value = .014). Participants with higher klotho also had lower estimated odds of weight loss and weakness, but these findings were not statistically significant. CONCLUSIONS Higher plasma klotho concentrations were associated with lower likelihoods of frailty and particularly exhaustion. Future studies should investigate modifiable mechanisms through which klotho may affect the frailty syndrome.
Apoptosis in diabetic retinopathy.

Diabetic retinopathy cause vision loss has already attracted wide attention,but because of diabetes is a multifactor disease,its research is not clear. In this paper,we make a comprehensive overview of the recent studies about retinal blood vessels and ganglion cell apoptosis in diabetic retinopathy. Indicate that diabetes can cause retinal blood vessels and ganglion cell apoptosis in a variety of mechanisms,apoptosis plays an important role in the occurrence and development of the diabetic retinopathy.
Images in clinical medicine. Myeloid sarcoma.

n engl j med 369;24 nejm.org december 12, 2013 2332 A 17-year-old boy presented with a 1-week history of proptosis of the left eye. Physical examination revealed a tumor involving the periorbital region (Panel A). Magnetic resonance imaging revealed an orbital mass (Panel B). Laboratory test results included a hemoglobin level of 89 g per liter, a platelet count of 90,000 per cubic millimeter, and a leukocyte count of 1100 per cubic millimeter. Morphologic examination of a bone marrow aspirate revealed 30% myeloblasts (Panel C, arrow). There were no circulating myeloblasts. A biopsy specimen of the orbital mass showed myeloid sarcoma. Myeloid sarcoma is a tumor composed of myeloid blasts that occurs at an extramedullary site. Myeloid sarcoma may occur on its own or concurrently with a myelodysplastic syndrome, myeloproliferative disease, or acute myeloid leukemia (AML), as seen in this case; on rare occasions, myeloid sarcoma precedes a diagnosis of AML by months or years. After the patient underwent induction chemotherapy, the mass disappeared and the eye returned to its normal position (Panel D). He subsequently underwent cord-blood transplantation, and at the 6-year follow-up, there was no evidence of recurrence of AML.
Effectiveness of Pilates‐based exercises on upper extremity disorders related with breast cancer treatment

&NA; Breast cancer treatment causes upper extremity (UE) impairments. This study aims to assess the efficacy of Pilates‐based exercises (PE) in comparison with combined exercise (CE) and home exercise (HE) groups, in the rehabilitation of UE disorders related with breast cancer treatment. Fifty‐five patients were randomly allocated to PE, CE (consisting of strengthening, stretching and range of motion [ROM] exercises) and HE groups (consisting of CE group exercises). Pain (using visual analogue scale), ROM (using digital goniometer), muscle strength (using dynamometer and pinch gauge), functional status (using Constant‐Murley scale and Disabilities of the Arm, Shoulder and Hand scale) were evaluated before and after intervention. For data analyses (using spss 21 version), one‐way ANOVA, paired samples t‐test and Kruskal‐Wallis test were performed (p ≤ .05 was considered statistically significant). The data obtained in this study revealed significant improvements in almost all the parameters measured in the PE and CE groups, and some improvements were superior to HE group. PE seemed to have resulted similar improvements in pain, muscle strength and functional status when compared to CE group. Therefore, PE seems to be an effective method of rehabilitation of patients with UE disorders related with breast cancer treatment, and might be considered for use as an alternative to CE in this population.
Complementary therapy use and health self-management among rural older adults.

OBJECTIVES This article describes dimensions of complementary therapy use among rural older adults, employs these dimensions to delineate sets of complementary therapy use, and describes the personal characteristics related to each set of complementary therapy use. METHODS Data are from in-depth interviews conducted with 62 African American and White rural older adults. RESULTS Three dimensions of complementary therapy use are delineated: types of therapies used, mindfulness in therapy use, and sharing information with conventional health care providers. The intersection of these dimensions indicates 5 patterned sets of complementary therapy use among rural older adults: (a) mindful use of only home remedies; (b) mindful use of home remedies and contemporary supplements; (c) mindful use of home remedies, contemporary supplements, and complementary practices; (d) nonmindful use of home remedies and contemporary supplements; and (e) use of conventional care only. Involvement in the 5 sets of therapy use is related to sex, ethnicity, educational attainment, and migration. DISCUSSION Understanding how older adults include sets of complementary therapies in their health self-management is important for improving their health care resources, expectations, awareness, and priorities.
Comparative evaluation of ultrasonography and CT in patients with abdominal trauma: A prospective study

Objectives: To assess the relative role of US and CT in patients with abdominal trauma and to compare it with operative findings or clinical outcome and also to suggest guidelines for imaging and management protocols based on the above results. Materials and Methods: Thirty-three consecutive and positive patients of abdominal trauma were evaluated with both ultrasonography (US) and computed tomography (CT). Thirty-one of them had blunt abdominal trauma. One patient had penetrating injury and another patient had blast trauma. Injuries to different organs were staged using organ injury scaling (OIS) system. Hemoperitoneum as detected on US and CT was scored. The US and CT findings were compared and correlated with the operative findings or clinical follow-up in conservatively managed cases Results: Patients with large hemoperitoneum required surgery more often. Grading of organ injuries did not correlate with need for surgery except for splenic injuries. In 25 patients, either US or CT would have been sufficient for arriving at a management decision. In seven patients, CT altered the management decision that was arrived at on the basis of US. One patient required angiography for diagnosis and vascular intervention. Conclusions: CT is better than US for the diagnosis of abdominal trauma. However US can be used as a useful initial modality. It is important that in all patients where US indicated presence of abnormality, in suboptimal US studies and in US-negative studies in symptomatic patients, the studies be supplemented with CT. Truly normal US scans in asymptomatic patients may be highly reliable for excluding significant organ injuries and these patients may be followed up without CT scan or admission.
Symptoms of patients with head and neck cancers undergoing radiotherapy

&NA; Radiotherapy is a reliable and effective treatment method for the treatment of head and neck cancers. This study was conducted as a descriptive work with the purpose of determining the symptoms experienced by patients with head and neck cancer who are undergoing radiotherapy. The study was carried out on 47 patients receiving treatment in oncology clinics. Data were obtained at mid‐radiotherapy (RT), at the end of radiotherapy and 1 month after the end of radiotherapy using the Memorial Symptom Assessment Scale (MSAS) and Personal Information Forms. The mean scores of MSAS GDI (Global Distress Index), MSAS Physical, MSAS Psychological and Total Memorial Symptom Assessment Scale, which were highest by the end of radiotherapy, declined during the 1‐month period following the end of radiotherapy. A statistically significant difference (p < .05) was found between the subscale groups in the evaluations made at mid‐RT, at the end of RT and 1 month after the end of RT. Patients generally experienced symptom frequency, severity and distress levels at highest rates at the end of RT. During the radiotherapy process, determining these symptoms will contribute to improve the well‐being of the patient. These results may be useful to control symptoms effectively.
Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014

Importance Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time. Objective To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. Design, Setting, and Population Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014. Exposures Sepsis was identified using clinical indicators of presumed infection and concurrent acute organ dysfunction, adapting Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria for objective and consistent EHR-based surveillance. Main Outcomes and Measures Sepsis incidence, outcomes, and trends from 2009-2014 were calculated using regression models and compared with claims-based estimates using International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe sepsis or septic shock. Case-finding criteria were validated against Sepsis-3 criteria using medical record reviews. Results A total of 173 690 sepsis cases (mean age, 66.5 [SD, 15.5] y; 77 660 [42.4%] women) were identified using clinical criteria among 2 901 019 adults admitted to study hospitals in 2014 (6.0% incidence). Of these, 26 061 (15.0%) died in the hospital and 10 731 (6.2%) were discharged to hospice. From 2009-2014, sepsis incidence using clinical criteria was stable (+0.6% relative change/y [95% CI, −2.3% to 3.5%], P = .67) whereas incidence per claims increased (+10.3%/y [95% CI, 7.2% to 13.3%], P < .001). In-hospital mortality using clinical criteria declined (−3.3%/y [95% CI, −5.6% to −1.0%], P = .004), but there was no significant change in the combined outcome of death or discharge to hospice (−1.3%/y [95% CI, −3.2% to 0.6%], P = .19). In contrast, mortality using claims declined significantly (−7.0%/y [95% CI, −8.8% to −5.2%], P < .001), as did death or discharge to hospice (−4.5%/y [95% CI, −6.1% to −2.8%], P < .001). Clinical criteria were more sensitive in identifying sepsis than claims (69.7% [95% CI, 52.9% to 92.0%] vs 32.3% [95% CI, 24.4% to 43.0%], P < .001), with comparable positive predictive value (70.4% [95% CI, 64.0% to 76.8%] vs 75.2% [95% CI, 69.8% to 80.6%], P = .23). Conclusions and Relevance In clinical data from 409 hospitals, sepsis was present in 6% of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014. The findings also suggest that EHR-based clinical data provide more objective estimates than claims-based data for sepsis surveillance.
Health and Health Insurance Trajectories of Mexicans in the Us

We study how the health and health insurance coverage of Mexican immigrants change with time in the US. Cross-sectional analyses suggest that approximately three decades of residency in the US is associated with a 9 to 11 percentage point (12% to 15%) decline in the probability of being uninsured for Mexican men and women. However, analysis using longitudinal data and fixed effects methods show that time in the US is unrelated to health insurance coverage. Both cross sectional and longitudinal analyses provide evidence of unhealthy assimilation--self-reported health declines slightly with time in the US.