Miracle-dz/UniFAR-FTUs huggingface dataset:
The Examination of Human Tissue for Carcinogenic Factors

Numerous experiments have been carried out to see if a carcinogenic factor could be detected in extracts of tumours or of tissues and body fluids from human subjects who have died of cancer. In this Institute we have used as test methods, application to the skin of the mouse, fluorescence spectroscopy, and inhibition of the dehydrogenase system such as is brought about by derivatives of some carcinogenic compounds (Boyland). Shabad, working in Leningrad, has been the first to report success in this field.1 His experiments were carried out with liver tissue obtained from a woman dying of gastric cancer with numerous metastases, but none in the liver. The ground liver was extracted with cold benzene and then evaporated, and the residue was injected subcutaneously in 5 male and 5 female mice. According to Neufach the temperature of the extract was never above 80 or 90°. Eight injections were given of 0.25 to 0.3 c.c. over a period of two months. Four males and 4 females were alive after eight months, and 3 tumours were obtained: 2 sarcomas in male mice after eight and three-quarters and nine months respectively and a carcinoma of mammary type in a female after nine months. Shabad states that no spontaneous sarcoma had been observed in this strain of mice over a period of ten years, and that mammary cancer occurs in only about 0.5 per cent of the females. The 2 sarcomas were transplanted through 25 and 26 generations respectively.2 In a second series of experiments Shabad prepared a hot benzene extract of the pooled bile taken at autopsy from the gallbladders of 6 persons—2 with cancer of the stomach, 2 with cancer of the lung, 1 each with retroperitoneal sarcoma and generalised lymphosarcomatosis. After evaporation of the benzene the residue was dissolved in olive oil and lard and injected subcutaneously in 35 mice. No local tumours were obtained in this series, but in both this and the first series many remote tumours occurred which, on the basis of a comparison with 553 untreated mice of the same strain, Shabad attributed to the action of the extract. The experiments described below are mainly an examination of Shabad's discovery, and the extension of it to other tissues.
Availability of comparative efficacy data at the time of drug approval in the United States.

CONTEXT Comparative effectiveness is taking on an increasingly important role in US health care, yet little is known about the availability of comparative efficacy data for drugs at the time of their approval in the United States. OBJECTIVE To quantify the availability of comparative efficacy data for new molecular entities (NMEs) approved in the United States. DATA SOURCES Approval packages publicly available through the online database of drug products approved by the US Food and Drug Administration (FDA). STUDY SELECTION Identification of efficacy studies that supported approval of each NME approved by FDA between 2000 and 2010. DATA EXTRACTION We determined whether eligible studies were head-to-head active controlled trials and whether the results of such studies were available in the approval packages. We recorded the approved indication, whether the NME was an orphan product, whether the NME had undergone priority review, and whether the control group was a specific active comparator or standard care. RESULTS Of 197 NMEs identified that met eligibility criteria, 100 (51% [95% confidence interval {CI}, 44%-58%]) met criteria for having comparative efficacy data available at the time of market authorization. After excluding NMEs designated as orphan products (n = 37) and those approved for indications for which no alternative treatments existed (n = 17), this proportion increased to 70% (95% CI, 62%-77%). The proportions of NMEs with available comparative efficacy data varied widely by therapeutic area, from 33% (95% CI, 9%-67%) for hormones and contraceptives to 89% (95% CI, 56%-99%) for diabetes medications. CONCLUSION Publicly available FDA approval packages contain comparative efficacy data for about half of NMEs recently approved in the United States and for more than two-thirds of NMEs for which alternative treatment options exist. We did not investigate the extent to which available comparative efficacy information is useful for clinical guidance.
Comparison of asthma and COPD patients' perception of appropriate metered-dose inhaler technique with a questionnaire and supervision based reference standard

Aim: To compare patient perception of correct metered-dose inhaler (MDI) technique with what is considered to be the right technique using a questionnaire and under direct supervision. Method: Asthmatic and COPD patients randomly recruited over a seven-month period from the medical wards and respiratory outpatients clinics, answered a standard questionnaire, which included patient self-assessment out of a maximum score of 10. This was followed by formal scoring out of a maximum score of 8, based on eight steps for proper MDI technique. The inhaler technique was scrutinised under direct supervision by the interviewer. The data collected was then analysed using Spearman9s correlation. Results: A total of 174 patients on MDI treatment were included: 118 (67.8%) were asthmatics and 56 (32.2%) COPD patients. Eighty-six asthmatics rated themselves at 9 or 10 on self-assessment but only 21 (17.8%) managed a maximum score of 8 on questionnaire and direct supervision (p=0.007). As regards COPD patients, 31 (55.4%) had a self-assessment score of 9 or 10 with only 3 patients (5.4%) managing a full score on objective assessment (p=0.04). Conclusion: There is a significant difference in both asthmatic and COPD patients comparing self- assessment and proper MDI technique. Most assume their technique is correct but medical supervision shows otherwise. Self-assessment shows COPD patients to be more uncertain with MDI technique and only few master it fully when compared to asthmatics. Revision and reinforcement of technique by professionals is necessary during admissions and follow up visits to decrease exacerbations and hospital visits.
Intravenous erythropoietin in patients with ST-segment elevation myocardial infarction: REVEAL: a randomized controlled trial.

CONTEXT Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. OBJECTIVE To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. DESIGN, SETTING, AND PATIENTS A prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single dose (60,000 U of epoetin alfa) efficacy phase; the Reduction of Infarct Expansion and Ventricular Remodeling With Erythropoietin After Large Myocardial Infarction (REVEAL) trial was conducted at 28 US sites between October 2006 and February 2010, and included 222 patients with STEMI who underwent successful percutaneous coronary intervention (PCI) as a primary or rescue reperfusion strategy. INTERVENTION Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. MAIN OUTCOME MEASURE Infarct size, expressed as percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging performed 2 to 6 days after study medication administration (first CMR) and again 12 ± 2 weeks later (second CMR). RESULTS In the efficacy cohort, the infarct size did not differ between groups on either the first CMR scan (n = 136; 15.8% LV mass [95% confidence interval {CI}, 13.3-18.2% LV mass] for the epoetin alfa group vs 15.0% LV mass [95% CI, 12.6-17.3% LV mass] for the placebo group; P = .67) or on the second CMR scan (n = 124; 10.6% LV mass [95% CI, 8.4-12.8% LV mass] vs 10.4% LV mass [95% CI, 8.5-12.3% LV mass], respectively; P = .89). In a prespecified analysis of patients aged 70 years or older (n = 21), the mean infarct size within the first week (first CMR) was larger in the epoetin alfa group (19.9% LV mass; 95% CI, 14.0-25.7% LV mass) than in the placebo group (11.7% LV mass; 95% CI, 7.2-16.1% LV mass) (P = .03). In the safety cohort, of the 125 patients who received epoetin alfa, the composite outcome of death, MI, stroke, or stent thrombosis occurred in 5 (4.0%; 95% CI, 1.31%-9.09%) but in none of the 97 who received placebo (P = .04). CONCLUSIONS In patients with STEMI who had successful reperfusion with primary or rescue PCI, a single intravenous bolus of epoetin alfa within 4 hours of PCI did not reduce infarct size and was associated with higher rates of adverse cardiovascular events. Subgroup analyses raised concerns about an increase in infarct size among older patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00378352.
Antimicrobial susceptibility pattern of methicillin-resistant strains of Staphylococcus aureus in a super specialty hospital

Introduction: Staphylococcus aureus is a major cause of infection, and methicillin-resistant strains are increasingly being reported worldwide. This study was carried out to evaluate the antibiotic susceptibility pattern of methicillin-resistant strains of S. aureus, isolated from clinical specimens from a super specialty hospital in Delhi. Materials and Methods: The study comprised of 80 strains of S. aureus isolated from various clinical specimens. From these isolates, methicillin-resistant strains were screened, and their susceptibility pattern to vancomycin, teicoplanin, daptomycin, and linezolid was detected using standard microbiological techniques. Results: Of the 80 strains, 53 strains were found to be methicillin resistant while the rest of the 27 strains were methicillin-susceptible. Four among the 53 strains were linezolid resistant, and eight were vancomycin-intermediate. Of the 8 strains, two were teicoplanin intermediate, and one was teicoplanin resistant. All the 53 strains were sensitive to daptomycin. Conclusion: In the current study, daptomycin was found to be the only drug to which all the isolates were susceptible. However, daptomycin resistance has also been reported from elsewhere. Therefore, all the recommended measures to control the emergence and spread of these strains must be followed strictly in all health-care systems.
Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.
Mortality following a cardiovascular or renal event in patients with type 2 diabetes in the ALTITUDE trial.

AIMS Patients with type 2 diabetes mellitus (T2DM) are at high risk of developing cardiovascular (CV) and renal disease. We examined the burden of, and risk of death following, CV and renal events in the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE), a randomized trial of alikiren vs. placebo. METHODS AND RESULTS We followed 8561 patients with T2DM and evidence of chronic kidney disease, CV disease, or both in ALTITUDE until the first non-fatal CV or renal event of myocardial infarction (MI), stroke, heart failure (HF), and end-stage renal disease (ESRD; initiation of dialysis, renal transplantation, or a serum creatinine concentration above 6.0 mg/dL) and then to death or censoring. Time-updated multivariable Cox models were used to estimate the relative risk of death following each event. In total 1008 patients (12%) experienced at least one first non-fatal CV or renal event (4.1% HF, 2.8% MI, 2.8% stroke, and 2.2% ESRD). Death occurred subsequently in 26.4% of those experiencing a first HF event, 29.7% of those experiencing an MI event, 23.7% of those experiencing a stroke, and 14.7% of those experiencing ESRD, and in 6.5% (488) of the 7553 patients (88%) who did not experience a non-fatal CV or renal event. Compared with patients who did not experience a non-fatal event, the adjusted hazard ratio for death was 5.9 (95% confidence interval 4.6-7.6) after HF, 9.7 (7.5-12.6) after MI, 7.1 (5.3-9.5) after stroke, and 5.8 (3.7-9.0) after ESRD. CONCLUSION The majority of deaths occurred in patients who did not experience a non-fatal CV or renal event, although the risk of death was higher following an event. Our findings illustrate continuing opportunities to reduce morbidity and mortality in patients with type 2 diabetes.
PTSD Trajectory, Co-morbidity, and Utilization of Mental Health Services among National Guard Soldiers

Abstract : This research will assess mental health and mental health service utilization over time among a representative sample of Reserve forces, within a multivariate causal framework that takes into account life course experiences and circumstances together with combat history, other military experience (e.g. humanitarian activity and activation for state missions) and civilian traumatic event experiences as determinants of mental health in this group. We focus not only on documenting the prevalence and correlates of PTSD and other mental illness and health service utilization among these forces, but also on documenting the trajectories of PTSD and co-occurring psychopathology over time among these forces. The scope includes developing, piloting and implementing a structured survey for a random sample of Reserve members. Findings from analyses of all four waves of the survey will be disseminated to key stakeholders. To date, we have constructed a survey for initial data collection as well as three subsequent waves that contains modules on (1) risk or protective factors for psychological morbidity over the life course (general traumas, psychological resources, life and family concerns), (2) mental health (depression, PTSD, emotional health history), (3) service utilization patterns (use of mental health resources). We have enrolled 1000 Reserves, and completed the baseline survey and three follow-up surveys. We have 2 manuscripts published, 2 under review, and 7 in preparation. Results have been disseminated at four national scientific conferences.
Assessment competencies among emergency nurses for responding in disaster situation with Objective Structured Clinical Examination

Introduction: Nurses are the first people that attend the accident site. Therefore, they must be able to take care of victims and have skill to prevent detrimental effects of disaster. The aim of this study was to determine competencies among Shahrekord emergency nurses responded in disaster situation with Objective Structured Clinical Examination (OSCE). Materials & Methods: This study was a descriptive study which 25 emergency nurses of educational hospital in Shahrekord were recruited by census statistical methods. Competency of nurses for responding in disaster situation were evaluated by utilizing 8-station objective structured clinical examination (OSCE). In each station "Task Based Checklist" has been used for evaluation. For measuring validity, content validity and for reliability, test re test was used. Data were analyzed by using SPSS/16. Findings: The mean scores of nurses' performance in 8 stations were less than average. In triage station was (3.5±1.6), life support (4.4±1.2), airway management (3.9±1.5), Chest tube insertion (4.9±1.5), naso gastric tube insertion (6.1±2.2), IV therapy (1.9±0.7), IV line insertion (5.4±1.3), suturing (8.6±1.5) urinary catheterization (9.1±1.5). Conclusion: Competencies of nurses in providing care in disaster were undesirable and less than average in all skills. So it is essential for nurses to acquire clinical and special skills to prepare for disaster situations
Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes.

CONTEXT The association of an adult tele-intensive care unit (ICU) intervention with hospital mortality, length of stay, best practice adherence, and preventable complications for an academic medical center has not been reported. OBJECTIVE To quantify the association of a tele-ICU intervention with hospital mortality, length of stay, and complications that are preventable by adherence to best practices. DESIGN, SETTING, AND PATIENTS Prospective stepped-wedge clinical practice study of 6290 adults admitted to any of 7 ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular) on 2 campuses of an 834-bed academic medical center that was performed from April 26, 2005, through September 30, 2007. Electronically supported and monitored processes for best practice adherence, care plan creation, and clinician response times to alarms were evaluated. MAIN OUTCOME MEASURES Case-mix and severity-adjusted hospital mortality. Other outcomes included hospital and ICU length of stay, best practice adherence, and complication rates. RESULTS The hospital mortality rate was 13.6% (95% confidence interval [CI], 11.9%-15.4%) during the preintervention period compared with 11.8% (95% CI, 10.9%-12.8%) during the tele-ICU intervention period (adjusted odds ratio [OR], 0.40 [95% CI, 0.31-0.52]). The tele-ICU intervention period compared with the preintervention period was associated with higher rates of best clinical practice adherence for the prevention of deep vein thrombosis (99% vs 85%, respectively; OR, 15.4 [95% CI, 11.3-21.1]) and prevention of stress ulcers (96% vs 83%, respectively; OR, 4.57 [95% CI, 3.91-5.77], best practice adherence for cardiovascular protection (99% vs 80%, respectively; OR, 30.7 [95% CI, 19.3-49.2]), prevention of ventilator-associated pneumonia (52% vs 33%, respectively; OR, 2.20 [95% CI, 1.79-2.70]), lower rates of preventable complications (1.6% vs 13%, respectively, for ventilator-associated pneumonia [OR, 0.15; 95% CI, 0.09-0.23] and 0.6% vs 1.0%, respectively, for catheter-related bloodstream infection [OR, 0.50; 95% CI, 0.27-0.93]), and shorter hospital length of stay (9.8 vs 13.3 days, respectively; hazard ratio for discharge, 1.44 [95% CI, 1.33-1.56]). The results for medical, surgical, and cardiovascular ICUs were similar. CONCLUSION In a single academic medical center study, implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with changes in best practice adherence and lower rates of preventable complications.
ON GROMOV-WITTEN INVARIANTS OF DEL PEZZO SURFACES

We compute Gromov–Witten invariants of any genus for Del Pezzo surfaces of degree ≥ 2. The genus zero invariants have been computed a long ago [P. Di Francesco and C. Itzykson, Quantum intersection rings, in The Moduli Space of Curves, eds. R. Dijkgraaf et al., Progress in Mathematics, Vol. 129 (Birkhauser, Boston, 1995), pp. 81–148; L. Gottsche and R. Pandharipande, The quantum cohomology of blow-ups of ℙ2 and enumerative geometry, J. Differential Geom.48(1) (1998) 61–90], Gromov–Witten invariants of any genus for Del Pezzo surfaces of degree ≥ 3 have been found by Vakil [Counting curves on rational surfaces, Manuscripta Math.102 (2000) 53–84]. We solve the problem in two steps: (1) we consider curves on , the plane blown up at one point, which have given degree, genus, and prescribed multiplicities at fixed generic points on a conic that avoids the blown-up point; then we obtain a Caporaso–Harris type formula counting such curves subject to arbitrary additional tangency conditions with respect to the chosen conic; as a result we count curves of any given divisor class and genus on a surface of type , the plane blown up at six points on a given conic and at one more point outside the conic; (2) in the next step, we express the Gromov–Witten invariants of via enumerative invariants of , using Vakil's extension of the Abramovich–Bertram formula.
Nifedipine for Inhibiting Threatened Preterm Labour in Siriraj Hospital

Objective: To assess the success rate and effects on maternal and fetal outcomes of nifedipine administered as a tocolytic agent to women in threatened preterm labour Methods: During 1st January to 31st October, 2007, a total of 53 pregnant women with threatened preterm labour between 20-36 weeks participated in this study. All women were inhibited contraction with nifedipine 20 mg. orally every 30 minutes for 3 times then maintenance with nifedipine SR 20 mg. every 12 hours until 34 weeks. If a neonatal intensive care unit was not available, the inhibition of labour was prolonged until 36 weeks of gestation. If there is any complication with nifedipine, the inhibition of contraction was changed to be bricanyl intravenous form. If there were contraindication to the use of bricanyl, magnesium sulphate was used. Results: 53 pregnant women with threatened preterm labour participated. The gestational age ranged from 28 to 35 weeks with the mean of 31.6 weeks of gestation. Failure of inhibition with nifedipine was found in 30/53 cases (57%) with a complication of maternal hypotension (90/60 mmHg) for 7 cases (13%) and one case of fetal distress. 23/53 (43%) cases were successful to inhibit contraction with nifedipine. Those patients who failed to inhibit contraction with nifedipine, 28 cases continued to inhibit contraction with bricanyl and 2 with magnesium sulphate (due to placenta previa). All were later successful to stop contraction with bricanyl and meagnesium sulphate. Ten pregnant women underwent caesarean section, 31 cases of normal delivery, 3 cases of vacuum extraction, and 2 cases referred to other hospitals (normal delivery). Seven cases were not delivered. The gestational age at delivery ranged from 29 to 40 weeks of gestation with the mean gestational age of 37.7 weeks. The babies’ weights ranged from 1,690 to 4,090 grams with the average body weight of 2,742 grams. Conclusion: Nifedipine cannot be used successfully to inhibit contraction in threatened preterm labour. Other medications can be tried to minimize the incidence of preterm labour.
Effects of Fluoxetine and Venlafaxine on the Salivary Gland - Experimental Study

Depression is the most common form of affective disorders and may range from discrete to severe. Various studies have worked with the hypothesis that depression arises from the deficiency of monoamines (noradrenaline, serotonin and dopamine), the most adequate treatment being to raise the supply of these neurotransmitters in the central nervous system (CNS). Statistical data have shown that depression has increased as a result of the longer life expectancy and is common among the elderly population (Glassman et al., 1984).