Miracle-dz/UniFAR-FTUs huggingface dataset:
Clobazam as an add-on in the management of refractory epilepsy.

BACKGROUND Epilepsy effects approximately 1% of the population, with up to 30% of patients continuing to have seizures despite antiepileptic drug treatment. OBJECTIVES To assess the efficacy and tolerability of clobazam when used as an add-on therapy for patients with refractory partial onset or generalised onset seizures. SEARCH STRATEGY We searched the following on 22nd March 2007: (a) The Cochrane Epilepsy Group Specialised Register; (b) The Cochrane Central Register of Controlled Trials (CENTRAL); (c) MEDLINE; (d) EMBASE; (e) Database of Abstracts of Reviews of Effectiveness (DARE); (f) American College of Physicians Journals; (g) BIOSIS. SELECTION CRITERIA Randomised trials of add-on clobazam, with adequate methods of allocation concealment, recruiting patients with drug refractory partial or generalised onset seizures, with a minimum treatment period of eight weeks. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and extracted relevant data. The following outcomes were assessed: 50% or greater reduction in seizures; seizure freedom; treatment withdrawal and adverse effects. MAIN RESULTS Four cross-over studies, representing 196 participants, were included. However, due to significant methodological heterogeneity and differences in outcome measures it was not possible to summarise data in a meta-analysis. Only two of the studies reported a 50% or greater seizure reduction compared to placebo; 57.7% and 52.4%. Side effects were only described in two of the studies, reportedly present in 36% and 85% of patients. AUTHORS' CONCLUSIONS Clobazam as an add-on treatment may reduce seizure frequency and may be most effective in partial onset seizures. However, it is not clear who will best benefit and over what time-frame. A large scale, randomised controlled trial conducted over a greater period of time, incorporating subgroups with differing seizure types, is required to inform clinical practice.
Baseline prevalence and predictors of liver fibrosis among HIV‐positive individuals: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

Liver disease is increasingly recognized in HIV‐positive individuals, even among those without viral hepatitis, partly as a result of the recent availability of noninvasive methods of liver fibrosis assessment. The objective of this substudy is to compare the effects of early versus deferred antiretroviral therapy (ART) on liver fibrosis progression.
ANTIBIOTIC SUSCEPTIBILITY AND RESISTANCE PATTERNS OF PSEUDOMONAS AERUGINOSA STRAINS ISOLATED FROM DIFFERENT CLINICAL SPECIMENS IN PATIENTS REFERRED TO THE TEACHING HOSPITALS IN KERMANSHAH (2001-2)

Background& Objectives : Pseudomonas aeruginosa is inherently resistant to many antibiotics at concentrations that can be achieved in vivo. This study was done to assess the susceptibility of P.aeruginosa strains, isolated from Kermanshahian patients, to the most commonly prescribed antibiotics. Materials and Methods : 50 clinical specimens collected and examined from July 2001 to July 2002 from three hospitals(Sina, Imam khomeini, Taleghani). MIC90 was determined by SIGMA powders and agar dilution method for the following antibiotics:Amikacin,Azlocillin,Aztreonam,Carbenicillin,Ceftazidime,Ciprofloxacin, Gentamicin, Imipenem, Mezlocillin, Norfloxacin, Ticarcillin and Tobramycin. Results: Resistance to Amikacin, Azlocillin, Aztreonam, Carbenicillin, Ceftazidime, Ciprofloxacin, Gentamicin, Imipenem, Mezlocillin, Norfloxacin, Ticarcillin and Tobramycin was 38%, 52%, 80% ,72%, 50%, 38%, 52%, 10%, 98%, 40%, 90% and 46%, respectively. Discussion : There is no significant difference between our results and others' studies. Imipenem was the most effective antibiotic against P.aeruginosa strains isolated from our patients.
A retrospective study of chemotherapy with cisplatin plus gemcitabine after the failure of gemcitabine monotherapy for biliary tract cancer.

OBJECTIVE Before the ABC-02 trial, because there was no standard chemotherapy for patients with advanced biliary tract cancer, we treated them with gemcitabine alone. However, recently cisplatin plus gemcitabine became the standard first-line chemotherapy. We assessed the benefits of gemcitabine plus cisplatin chemotherapy after failed gemcitabine monotherapy. METHODS We retrospectively examined patients with advanced biliary tract cancer who were treated with gemcitabine plus cisplatin chemotherapy after failed gemcitabine monotherapy. They had adequate organ function, including renal function and Eastern Cooperative Oncology Group performance status 0-1. The treatment consisted of cisplatin (25 mg/m(2) of body surface area) plus gemcitabine (1000 mg/m(2)) on Days 1 and 8 for every 3 weeks. RESULTS Between December 2010 and January 2013, 20 patients were treated. The median age was 63 years. There were 15 males and 5 females. The ratio of intrahepatic bile duct, gall bladder and extrahepatic bile duct was 9:6:5. The ratio of locally advanced and metastatic disease was 2:18, and the ratio of PS0 and PS1 was 5:15. The objective response rate was 15.0%, and the tumour control rate was 60.0%. The median progression-free survival was 6.5 months (95% confidence interval, 2.1-6.9 months). The median overall survival was 13.7 months (95% confidence interval, 8.3-19.7 months). Grade 3-4 toxic events included neutropenia (30%), anaemia (20%) and thrombocytopenia (5%). CONCLUSION Cisplatin plus gemcitabine could be an optional therapy for unresectable or recurrent biliary tract cancer after failed gemcitabine monotherapy.
Clinicopathological analysis of patients with non-muscle-invasive bladder cancer: prognostic value and clinical reliability of the 2004 WHO classification system.

OBJECTIVE The aim of this study was to clarify the prognostic value and clinical reliability of the 2004 World Health Organization classification system of non-muscle-invasive bladder cancer. METHODS Between January 1995 and November 2010, 153 patients were diagnosed with non-muscle-invasive bladder cancer. We used a substage system that discerns T1-microinvasive (T1m, 42 patients) and T1-extensive-invasive (T1e, 37 patients) cancers. RESULTS There were 2 (1.3%), 89 (58.2%) and 62 (40.5%) cases of Grade 1-3 urothelial carcinoma, respectively, on the basis of the 1973 World Health Organization classification system. Of these, 37 (24.2%) and 116 (75.8%) were graded as low and high on the basis of the 2004 World Health Organization classification system. All of the cases with progression (15 patients) were diagnosed as high grade at the time of primary transurethral resection of the bladder tumor. Based on the Kaplan-Meier analysis, the 2004 World Health Organization classification system accurately predicted tumor recurrence (P = 0.029) and progression (P = 0.031). The 5-year recurrence-free survival rates in patients with low-grade and high-grade tumors were 68.7 and 47.1%, and the 5-year progression-free survival rates were 100 and 89.0%, respectively. In the high-grade T1 cases, the substage (T1m or T1e) was a significant predictor of tumor recurrence (P = 0.001) and progression (P = 0.020). CONCLUSIONS The 2004 World Health Organization classification system accurately predicts the risk of recurrence in primary non-muscle-invasive bladder cancer cases and has the same accuracy when predicting the risk of progression as the 1973 World Health Organization classification. Furthermore, the substaging system for high-grade T1 tumors is useful in predicting both recurrence and progression.
Regional medical professionals' confidence in providing palliative care, associated difficulties and availability of specialized palliative care services in Japan.

BACKGROUND Although confidence in providing palliative care services is an essential component of providing such care, factors relating to this have not been investigated in Japan. OBJECTIVE This study aimed to explore confidence in the ability to provide palliative care and associated difficulties and to explore correlations between these variables. Design A cross-sectional mail survey of medical doctors and registered nurses in Japan was performed as part of a regional intervention trial: the Outreach Palliative Care Trial of Integrated Regional Model study. Subjects Questionnaires were sent to 7905 medical professionals, and 409 hospital doctors, 235 general practitioners, 2160 hospital nurses and 115 home visiting nurses completed them. RESULTS Confidence in providing palliative care was low and difficulties frequent for all types of medical professionals assessed. In particular, only 8-24% of them, depending on category, agreed to 'having adequate knowledge and skills regarding cancer pain management'. In particular, 55-80% of medical professionals acknowledged difficulty with 'alleviation of cancer pain'. Multiple regression analysis revealed that confidence was positively correlated with the amount of relevant experience and, for medical doctors, with 'prescriptions of opioids (per year)'. Moreover, difficulties were negatively correlated with the amount of relevant clinical experience. CONCLUSIONS Effective strategies for developing regional palliative care programs include basic education of medical professionals on management of cancer-related pain (especially regarding opioids) and other symptoms.
Vigilância de fatores de risco para doenças crônicas por inquérito telefônico nas capitais dos 26 estados brasileiros e no Distrito Federal (2006)

OBJETIVO: Descrever metodos e resultados iniciais do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas nao Transmissiveis por Inquerito Telefonico - VIGITEL implantado no Brasil em 2006. METODOS: O VIGITEL estudou amostras probabilisticas da populacao com 18 ou mais anos de idade residente em domicilios conectados a rede de telefonia fixa de cada uma das capitais dos 26 Estados brasileiros e do Distrito Federal (54.369 individuos no total, sendo pelo menos 2.000 por cidade). A amostragem foi realizada a partir de cadastros eletronicos completos das linhas residenciais fixas de cada cidade, envolvendo sorteio de linhas (domicilios) e sorteio de um morador por linha para ser entrevistado. O questionario aplicado investigou caracteristicas demograficas e socioeconomicas, padrao de alimentacao e de atividade fisica, consumo de cigarros e de bebidas alcoolicas, e peso e altura recordados, entre outros quesitos. Estimativas sobre a frequencia de fatores de risco selecionados, estratificadas por sexo e acompanhadas de Intervalo de Confianca de 95%, foram calculadas para a populacao adulta de cada cidade empregando-se fatores de ponderacao que igualam a composicao sociodemografica da amostra em cada cidade aquela observada no Censo Demografico de 2000. Estimativas para o conjunto das cidades empregam fator de ponderacao adicional que leva em conta a populacao de adultos de cada cidade. RESULTADOS: Os cinco fatores de risco selecionados (tabagismo, consumo abusivo de bebidas alcoolicas, excesso de peso, consumo de carnes com excesso de gordura e sedentarismo) tenderam a ser mais frequentes em homens do que em mulheres. Dentre os fatores de protecao, o consumo regular de frutas e hortalicas foi mais frequente em mulheres do que em homens, observando-se situacao inversa no caso da atividade fisica de lazer. Diferencas substanciais na frequencia dos fatores de risco e protecao foram observadas entre as cidades, com padroes de distribuicao regional diferenciados por fator. DISCUSSAO: O desempenho do sistema, avaliado a partir da qualidade dos cadastros telefonicos e de taxas de resposta e de recusas, mostrou-se adequado e, de modo geral, superior ao encontrado em sistemas equivalentes existentes em paises desenvolvidos. O custo do sistema de R$ 31,15 por entrevista realizada, foi a metade do custo observado no sistema americano de vigilância de fatores de risco para doencas cronicas por inquerito telefonico e um quinto do custo estimado em inquerito domiciliar tradicional realizado recentemente no Brasil.
HIV‐infected patients' beliefs about their chronic co‐treatments in comparison with their combined antiretroviral therapy

Thanks to the success of combination antiretroviral therapy (cART), HIV‐infected patients can have almost a normal life expectancy. This has resulted in an aging HIV‐infected population with other chronic comorbidities such as cardiovascular diseases, osteoporosis, and depression. Our hypothesis is that patients' perceptions of and attitudes towards their cART, which is perceived as crucial to their survival, differ from their beliefs about their co‐treatments, and this may have an impact on their medication adherence.
Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie.

BACKGROUND Bile duct injuries (BDIs) sustained during a cholecystectomy still remain a major surgical problem, and it is still not clear whether the injury should be repaired immediately or a delayed repair is preferred. METHODS A retrospective national French survey was conducted to compare the results of immediate (at time of cholecystectomy), early (within 45 days after a cholecystectomy) and late (beyond 45 days after a cholecystectomy) surgical repair for BDI sustained during a cholecystectomy. RESULTS Forty-seven surgical centres provided 640 cases of bile duct injury sustained during a cholecystectomy of which 543 were analysed for the purpose of the present study. The timing of repair was immediate in 194 cases (35.7%), early in 216 cases (39.8%) and late in 133 cases (24.5%). The type of repair was a suture repair in 157 cases (81%), and a bilio-digestive reconstruction in 37 cases (19%) for immediate repair; a suture repair in 119 cases (55.1%) and a bilio-digestive anastomosis in 96 cases (44.9%) for the early repair; and a bilio-digestive reconstruction in 129 cases (97%) and a suture repair in 4 cases (3%) for late repair. A second procedure was required in 110 cases (56.7%) for immediate repair, 80 cases (40.7%) for early repair (P < 0.05) and in 9 cases (6.8%) for late repair (P < 0.001). CONCLUSION The timing of surgical repair for a bile duct injury sustained during a cholecystectomy influences significantly the rate of a second procedure and a late repair should be preferred option.
Collaborative diabetes virtual clinics – a service evaluation and clinical audit

Abstract Background: Diabetes management in primary care is becoming increasingly complex. Integrated working between primary and specialist care teams is important in addressing this complexity. Diabetes virtual clinics (DVC) provide an opportunity for the diabetes specialist team to work collaboratively with the primary care team. Aim: To evaluate the impact of a DVC on the clinical management and care outcomes of patients in primary care settings. Methods: A prospective clinical audit of DVC patients was performed in seven general practices comparing data, at baseline and at 6 months. The audit measured changes in care provision and clinical performance. The primary audit standard was that 50% of cases with a baseline glycated haemoglobin (HbA1c) ≥58 mmol/mol (7.5%) would optimise HbA1c by a clinical significant reduction of 6 mmol/mol (0.4%). Results: The audit examined 113 cases that were exposed to the DVC. Data were available on 73 cases at 6 months. The main theme for case discussion was treatment modification and titration (48%, n = 54), followed by: managing co-morbidities (24%, n = 21) and psychosocial factors (14%, n = 12). Primary care was the most common pathway identified, 35% (n = 40) cases avoided being referred to specialist care and 21 (23%) cases were transferred from specialist to primary care. At 6 months, HbA1c reduced by 7 mmol/mol (0.46%) from 73 mmol/mol (8.79%) to 67 mmol/mol (8.32%), p = 0.001. The audit standards were exceeded with 85% of patients achieving an improvement in their glycaemic control and 57% having a reduction in the HbA1c of ≥6 mmol/mol (0.4%). Conclusions: The DVC resulted in a clinically and statistically significant improvement in HbA1c. It has also meant that more patients can be treated in primary care without the need for referral to specialists. The DVC could be an effective model for integrated working between primary and diabetes specialist services, providing an opportunity for shared learning.
Endothelin receptor antagonists for pulmonary arterial hypertension.

BACKGROUND Pulmonary arterial hypertension is a devastating disease, which leads to right heart failure and premature death. Recent evidence suggests that endothelin receptor antagonists may be promising drugs in the treatment of pulmonary arterial hypertension. OBJECTIVES To evaluate the efficacy of endothelin receptor antagonists in pulmonary arterial hypertension. SEARCH STRATEGY We searched CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE, and the reference section of retrieved articles. Searches are current as of Februray 2008. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-randomised controlled trials involving patients with pulmonary arterial hypertension. DATA COLLECTION AND ANALYSIS Five review authors independently selected studies, assessed study quality and extracted data. MAIN RESULTS Five new studies have been added to this updated review, which now includes 11 randomised controlled trials involving 1457 patients. All the trials were of relatively short duration (12 weeks to 6 months). After treatment, patients treated with endothelin receptor antagonists could walk on average 33.7 metres (95% confidence interval [CI] 24.9 to 42.5 metres) further than those treated with placebo in a 6 minute walk test. Endothelin receptor antagonists improved more patients' World Health Organization/New York Heart Association (WHO/NYHA) functional class status than placebo (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.2 to 2.1), and reduced the odds of functional class deterioration compared to placebo (OR 0.26; 95% CI 0.16 to 0.42 ). There was a trend for endothelin receptor antagonists to reduce mortality (OR 0.48; 95% CI 0.21 to 1.09), and limited data suggest that endothelin receptor antagonists improve Borg dyspnoea score and cardiopulmonary haemodynamics in symptomatic patients. Hepatic toxicity was not common, and endothelin receptor antagonists were well tolerated in this population. AUTHORS' CONCLUSIONS Endothelin receptor antagonists can increase exercise capacity, improve WHO/NYHA functional class, prevent WHO/NYHA functional class deterioration, reduce dyspnoea and improve cardiopulmonary haemodynamic variables in patients with pulmonary arterial hypertension with WHO/NYHA functional class II and III. However, there was only a trend towards endothelin receptor antagonists reducing mortality in patients with pulmonary arterial hypertension. Efficacy data are strongest in those with idiopathic pulmonary hypertension.
Metabolic Drug Interactions

Now the multi-drug therapy becomes common for most patients.The ADRs caused by drug interactions become more and more serious,which is an important fact for doctors and patients.So,the study on metabolic drug interactions,known a little before,is mainly a hot spot.The adverse drug interactions can be avoided by knowing the enzymology basis of drug metabolism,common substrates,inductors,inhibitors involved and using the same kind of drugs rationally.This article reviews the progress on metabolic drug interactions in order to cause the attention of medical staff and take measures to cut down the frequency of ADRs caused by unreasonable metabolic drug interactions.
Radiofrequency vessel-sealing system versus the clamp-crushing technique in liver transection: results of a prospective randomized study on 100 consecutive patients.

BACKGROUND Liver transection is considered a critical factor influencing intra-operative blood loss. A increase in the number of complex liver resections has determined a growing interest in new devices able to 'optimize' the liver transection. The aim of this randomized controlled study was to compare a radiofrequency vessel-sealing system with the 'gold-standard' clamp-crushing technique. METHODS From January to December 2012, 100 consecutive patients undergoing a liver resection were randomized to the radiofrequency vessel-sealing system (LF1212 group; N = 50) or to the clamp-crushing technique (Kelly group, N = 50). RESULTS Background characteristics of the two groups were similar. There were not significant differences between the two groups in terms of blood loss, transection time and transection speed. In spite of a not-significant larger transection area in the LF1212 group compared with the Kelly group (51.5 versus 39 cm(2) , P = 0.116), the overall and 'per cm(2) ' blood losses were similar whereas the transection speed was better (even if not significantly) in the LF1212 group compared with the Kelly group (1.1 cm(2) /min versus 0.8, P = 0.089). Mortality, morbidity and bile leak rates were similar in both groups. CONCLUSIONS The radiofrequency vessel-sealing system allows a quick and safe liver transection similar to the gold-standard clamp-crushing technique.
Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study.

BACKGROUND The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition. METHODS Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally. RESULTS Bile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5-15 times greater risk of intervention required in this group (P < 0.001). CONCLUSION The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.
The prognostic value of stroma in pancreatic cancer in patients receiving adjuvant therapy.

BACKGROUND Pancreatic ductal adenocarcinoma (PDA) is comprised of a prominent desmoplastic stromal compartment and only 10-40% of the tumour consists of PDA cells. However, how stromal components should be assessed and how the characteristics of the stromal compartment determine clinical outcomes in PDA patients remain unknown. METHOD A cohort of 66 consecutive patients who underwent pancreaticoduodenectomy and were primarily followed at Johns Hopkins Hospital between 1998 and 2004, and treated with adjuvant therapy, were included in a retrospective analysis. Resected PDA blocks with good tissue preservation were available for all patients. A new, computer-aided, quantitative method was developed to assess the density and activity of stroma in PDAs and the associations of these characteristics with clinical outcomes. RESULTS High stromal density in resected PDA was found to be significantly associated with longer disease-free [adjusted hazard ratio (aHR) 0.39; P = 0.001] and overall (aHR 0.44; P = 0.004) survival after adjusting for the use of pancreatic cancer vaccine therapy, as well as gender and resection margin positivity. Stromal activity, representing activated pancreatic stellate cells in PDAs, was not significantly associated with the prognosis of resected PDAs. CONCLUSIONS These results illustrate the complexity of the role of stroma in PDAs. Further exploration of the prognostic ability of the characteristics of stroma is warranted.