Miracle-dz/UniFAR-FTUs huggingface dataset:
Changes in Graves’ Ophthalmopathy after Radioiodine and Anti-Thyroid Drug Treatment of Graves’ Disease from 2 Prospective, Randomized, Open-Label, Blinded End Point Studies

Abstract Aims: A significant association between radioiodine therapy (RIT) and the development or the worsening of pre-existing Graves’ ophthalmopathy (GO) has been reported. This post-hoc analysis of 2 studies attempted to describe the changes observed in pre-existing or new-onset GO following RIT with the goal of euthyroidism rather than hypothyroidism and to describe the relationship GO changes and the final outcome. Patients and Methods: In 2 prospective, randomized open-label blinded endpoint trials, patients received radioiodine alone; or, patients received radioiodine or antithyroid drug therapy (ATD). The severity and activity of GO were assessed during a 9–12-year follow-up. The study end points in study 1 were euthyroidism, hyperthyroidism, hypothyroidism, and changes in GO. In study 2, the end points were euthyroidism, hyperthyroidism, hypothyroidism, relapse, and changes in GO. Results: Both RIT and ATD were associated with worsening GO and new-onset GO. Both RIT and ATD led to similar aggravation of pre-existing GO or the development to new-onset GO. After RIT or ATD, the euthyroid patients (without levothyroxine substitution) demonstrated an improvement in GO, with 78–89% patients with preexisting GO exhibiting improvement, whereas hyperthyroid, hypothyroid and relapsed patients had worsening or new-onset GO. Conclusions: Thyroid function is a dominant risk factor. Thyroid function may be the most important determinant in worsening or new-onset GO in both the natural disease course and in treated patients, independent of the kind of treatment. Therefore, we recommend euthyroidism as a goal of treatment.
COMPUTED TOMOGRAPHIC, RADIOGRAPHIC, AND ENDOSCOPIC TRACHEAL DIMENSIONS IN ENGLISH BULLDOGS WITH GRADE 1 CLINICAL SIGNS OF BRACHYCEPHALIC AIRWAY SYNDROME.

Tracheal hypoplasia is commonly seen in English Bulldogs affected with brachycephalic airway syndrome. Previously published diagnostic criteria for tracheal hypoplasia in this breed have been a radiographic tracheal diameter:tracheal inlet ratio (TD:TI) < 0.12 or a tracheal diameter:third rib diameter ratio (TD:3R) < 2.0. Computed tomography has become increasingly used for airway evaluation, however published information is lacking regarding CT tracheal dimensions in English Bulldogs. Objectives of this prospective cross-sectional study were to describe radiographic and CT tracheal dimensions in a sample of clinically normal English Bulldogs and compare these values with tracheoscopy scores. Computed tomography (n = 40), radiography (n = 38), and tracheoscopy (n = 40) studies were performed during a single general anesthesia session for each included dog. Tracheal measurements were recorded at three locations: cervical, thoracic inlet, and thorax. Tracheal diameters were narrowest at the thoracic inlet with all techniques. Computed tomographic measurements averaged 19% greater than radiographic measurements. All included dogs had radiographic tracheal measurements greater than the previously published criteria for tracheal hypoplasia. Mean CT TD:TI was 0.26 (± 0.03, 0.20-0.33), and mean CT TT:3R was 2.27 (± 0.24, 1.71-2.74). Radiographic TD:TI and CT TD:TI were significantly correlated (P = 0.00); however radiographic TT:3R and CT TT:3R were not significantly correlated (P = 0.25). Tracheoscopy identified hypoplastic changes in all dogs and tracheoscopy scores were not correlated with CT or radiography diameter measurements. In conclusion, findings indicated that some CT and radiographic tracheal diameter measurements were comparable in English Bulldogs however diameters for both imaging techniques were not comparable with tracheoscopy scores.
Match Performance and Physiological Capacity of Female Elite Team Handball Players

Abstract The present study evaluated the physical demands imposed on female elite team handball players in relation to playing position. Female elite team handball field players were examined during match-play over a 5-year period using video based computerized locomotion analysis of tournament matches. In addition, physiological measurements during match-play and in separate physical tests were carried out. A total distance of 4 002±551 m (group means±SD) was covered per match with a total effective playing time of 50:42±5:50 min:s, while full-time players covered 4 693±333 m. On average, each player (n=83) performed 663.8±99.7 activity changes per match, and the mean speed was 5.31±0.33 km · h−1. High-intensity running constituted 0.8±0.5% of total effective playing time per match corresponding to 2.5±1.8% of the total distance covered. The amount of high-intensity running was reduced (p<0.05) 21.9% in the second half (44.9±16.8 m) compared to the first (57.5±21.3 m). Maximal oxygen uptake (VO2-max) was 3.49±0.37 l O2 · min−1 corresponding to 49.6±4.8 ml O2 · min−1 · kg−1. Mean relative workload during match-play was 79.4±6.4% of VO2-max. Mean total running distance in the Yo-Yo intermittent recovery test (level 1) was 1 436±222 m, which was greater in wing players (1 516±172 m, p<0.05) than pivots (1 360±118 m) and backcourt players (1 352±148 m). In conclusion, modern female elite team handball is a physically demanding intermittent team sport, where players are exposed to high relative workloads with substantial estimated aerobic energy expenditure interspersed by short periods of dominant anaerobic energy production as reflected by the limited amount of high-intensity running. Indications of fatigue and a resulting decline in physical performance were identified, since the amount of high-intensity running and the relative workload levels decreased in the second half. Positional differences were observed, with wing players covering a greater total distance than backcourt players, performing more high-intensity running and demonstrating a better intermittent recovery capacity (Yo-Yo test outcome) compared to both backcourt players and pivots.
Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block†

Background Peripheral nerve stimulation is commonly used for nerve localization in regional anaesthesia, but recommended stimulation currents of 0.3–0.5 mA do not reliably produce motor activity in the absence of intraneural needle placement. As this may be particularly true in patients with diabetic neuropathy, we examined the stimulation threshold in patients with and without diabetes. Methods Preoperative evaluation included a neurological exam and electroneurography. During ultrasound-guided popliteal sciatic nerve block, we measured the current required to produce motor activity for the tibial and common peroneal nerve in diabetic and non-diabetic patients. Proximity to the nerve was evaluated post-hoc using ultrasound imaging. Results Average stimulation currents did not differ between diabetic (n=55) and non-diabetic patients (n=52). Although the planned number of patients was not reached, the power goal for the mean stimulation current was met. Subjects with diminished pressure perception showed increased thresholds for the common peroneal nerve (median 1.30 vs. 0.57 mA in subjects with normal perception, P=0.042), as did subjects with decreased pain sensation (1.60 vs. 0.50 mA in subjects with normal sensation, P=0.038). Slowed ulnar nerve conduction velocity predicted elevated mean stimulation current (r=−0.35, P=0.002). Finally, 15 diabetic patients required more than 0.5 mA to evoke a motor response, despite intraneural needle placement (n=4), or required currents ≥2 mA despite needle-nerve contact, vs three such patients (1 intraneural, 2 with ≥2 mA) among non-diabetic patients (P=0.003). Conclusions These findings suggest that stimulation thresholds of 0.3–0.5 mA may not reliably determine close needle-nerve contact during popliteal sciatic nerve block, particularly in patients with diabetic neuropathy. Clinical trial registration NCT01488474
Haemodynamic and cerebral oxygenation during paediatric laparoscopy in fluid optimized patients.

regarding equipment and assistance for paediatric emergency surgery. The principal finding of the present survey was that 77.1% of respondents from DGHs and university hospitals encountered difficulties, either related to a lack of specialized personnel (67.7%) or because of a lack of age-appropriate equipment (9.4%), when carrying out emergency surgery for children (Fig. 1). Only 27.1% had a 24 h cover for paediatric emergency surgery. Half of all paediatric emergency procedures are carried out by the general surgeon and the anaesthetist on duty. Only 27.6% responded that they had a dedicated, specialized paediatric team. Two out of every 10 children admitted for emergency surgery would be transferred to a specialist paediatric centre. Local hospital guidelines standardizing paediatric emergency procedures were missing in 77.9% of DGHs and university hospitals. Half of the respondents (46.1%) reported having a lower limit for age or weight, or both in children undergoing elective surgery during the daytime. Regarding basic airway equipment, such as laryngeal masks, tracheal tubes of paediatric and neonatal sizes, Guedel airways, and facemasks, these were available in the majority of hospitals (90%). However, equipment for a difficult paediatric airway, such as a video laryngoscope or fibre-optic broncoscope, was on hand for only one third of respondents (29 and 39%, respectively). When analysing data for geographical differences, there was a gradient between northern and central Italy and the south, probably reflecting the socioeconomic north–south divide of the country. The present survey reveals deficiencies for safe anaesthetic care in the critically ill child in non-specialized paediatric hospitals. Similar findings regarding anaesthesia and surgery for paediatric emergency surgery have been reported previously in other European countries. 2 A lack of appropriately trained staff seems to be a major issue. Training and regular retraining programmes should be mandatory for anaesthetists who are not working with children on a regular basis. The introduction of audits and appraisals might be helpful to assess proficiency. National guidelines and hospital guidelines should be established, especially for those places where there is no 24 h cover for paediatric emergency surgery, in order to facilitate and standardize timing and the course of procedures as well as transfer to specialized paediatric centres in order to guarantee a safe outcome. The limits of the present survey are related to a possible selection bias regarding experience and geographical region. Despite this, the survey provides an interesting insight into practice for paediatric emergency surgery in non-specialist hospitals.
Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants.

BACKGROUND Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment. METHODS From 01.10. 2012 to 31.12. 2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation. RESULTS A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34). CONCLUSIONS Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations. CLINICAL TRIAL REGISTRATION NCT01718561.
Re-analysis of Safety Data Supporting Doxylamine Use for Nausea and Vomiting of Pregnancy

Abstract Antihistamines are commonly used to treat nausea and vomiting of pregnancy (NVP). We re-analyzed the 24 primary studies cited in a 1997 meta-analysis that concluded antihistamine use for NVP was safe as they had been studied in more than 200,000 participating women and the pooled odds ratio for congenital malformations was 0.76 (95% confidence interval [CI]: 0.60–0.94). Our analysis of this meta-analysis showed that 139,414 women were included in 22 original studies involving antihistamines, 129,108 of which were in studies involving doxylamine. In these studies, 23,485 women were exposed to antihistamines, 14,624 of which were exposed to doxylamine. The summary relative risk (cohort studies) and odds ratio (case–control studies) for congenital malformations from antihistamine exposure were 1.09 (95% CI: 1.01–1.18) and 1.04 (95% CI: 0.91–1.19), and for doxylamine exposure, the summary relative risk and odds ratio were 0.94 (95% CI: 0.80–1.10) and 1.07 (95% CI: 0.93–1.23), respectively. Although not a new systematic review, our re-analysis demonstrates that the safety data for antihistamines, and doxylamine in particular, are based on many fewer than 200,000 participating women and exposures, and that doxylamine use is not associated with a decreased risk of malformations as previously reported.
The Lost Generation: Impact of the 56-hour EWTD on Current Surgical Training

The reform of specialist surgical training – the New Deal (1991), the Calman report (1993) and the implementation of the European Working Time Directive (EWTD, 1998) – has resulted in shorter training periods with reduced working hours. The Calman reform aimed to improve and structure training with regular assessment and supervision whereas the New Deal and the EWTD have concentrated predominantly on a reduction in hours. The adoption of full or partial shift work to provide surgical cover at night compliant to a 56-hour working week, as stipulated by phase one of the EWTD, has resulted in daytime hospital attendance for surgical trainees of an average three days per week despite almost universal acknowledgement of the limited training opportunities available at night.
Rehabilitation of the laryngectomee

Although there still may be some difference of opinion as to the relative indications for radiation and surgery respectively in the treatment of larynx cancer, nevertheless, there can be no question but that, in certain cases, total laryngectomy is the only solution. A recent survey has shown that in 1947 this operation was performed at least 846 times in the United States,1 and it is probable that the number is steadily increasing. When total laryngectomy is advised, the family doctor will often be present at the consultation, and the patient may hesitate to consent to the procedure without the approval of his personal physician. Following the operation, the family doctor can play a significant role in the rehabilitation period, both in keeping up the patient's morale for learning a new method of speech and in the social and occupational readjust ments that may be necessary under new and somewhat altered conditions of life. The purpose of this communica tion is to discuss both the surgical and psychological aspects of total laryngec tomy from the standpoint of the patient and his family doctor.
Pattern of skin diseases in a peripheral hospital's skin OPD: A study of 2550 patients

This study was done amongst 2550 consecutive skin patients in our male OPD. Infective dermatoses was seen in 36.41% and allergic diseases in 29.88% of our patients. New cases of leprosy accounted for 5.64% of our cases, which we consider is a disturbing trend. Occupational dermatoses was seen 15.24% of our cases. Farmers and agricultural labourers comprised the largest segment (37.72%) of our patients.
An Audit of Fibreoptic Intubation Training Opportunities in a UK Teaching Hospital

Airway management is the foundation upon which anaesthesia is built, and fibreoptic intubation (FOI) is a key facet of this skill. Despite this, many trainee anaesthetists in the UK have been unable to perform sufficient FOIs to gain competence. We aimed to establish the incidence of FOI in adult patients, in a UK teaching hospital, in order to determine what FOI training opportunities actually exist. During the study period (from October 1st, 2008, to September 30th, 2009) an estimated 11 712 general anaesthetics were undertaken that necessitated tracheal intubation. In 141 of these cases FOIs were performed giving an incidence of FOI of 1.2% (95% confidence interval 1%–1.4%). Of these, 86 (61%) were in awake and 55 (39%) in anaesthetised patients. Only 16 (11%) of the FOIs were done solely for the purposes of training. We suggest that a greater number of FOIs should be undertaken to allow trainees to gain and consultants to maintain the FOI expertise necessary for the provision of safe anaesthesia.
Sind stationäre Rehabilitation oder ambulante Physiotherapie bei Patienten mit muskuloskelettalen Problemen wirkungsvoll und landen Patienten auf dem richtigen Behandlungspfad

: The aim of the present study was to investigate the effectiveness of an inpatient rehabilitation program and outpatient physiotherapy, respectively. Moreover, we wanted to know whether the referral to these two treatment paths was appropriate with regard to the patient's initial health status. According to the referring physician's indication patients with health problems in the cervical, lumbar spine, arm or leg were treated by an inpatient rehabilitation program or by outpatient physiotherapy. These two consecutively recruited patient cohorts were then compared. Those patients treated by the inpatient rehabilitation program differed from the outpatient group with regard to the initial health status and to age. Patients with musculoskeletal problems, who underwent an inpatient rehabilitation program, showed a significantly worse health and functional status than the outpatient group. Therefore, it can be concluded that the indication towards inpatient rehabilitation or outpatient physiotherapy was correctly given by the referring physicians. Patients treated by outpatient physiotherapy did also show a reduced health and functional status in comparison to the average population. Both types of treatment led to statistically significant and clinically relevant improvement of both the health and functional status in all patient groups.
Postoperative pulmonary complications

Postoperative pulmonary complications (PPCs) are common, costly, and increase patient mortality. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug. The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. Risk factors for PPC development are numerous, and clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care. Many validated risk prediction models are described. These have been useful for improving our understanding of PPC development, but there remains inadequate consensus for them to be useful clinically. Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. Further evidence for the most beneficial level of PEEP is required, and on-going randomized trials will hopefully provide more information. When PEEP is used, it may be useful to precede this with a recruitment manoeuvre if atelectasis is suspected. For high-risk patients, surgical time should be minimized. After surgery, nasogastric tubes should be avoided and analgesia optimized. A postoperative mobilization, chest physiotherapy, and oral hygiene bundle reduces PPCs.
Outcomes of Limb-Sparing Surgery Using Two Generations of Metal Endoprosthesis in 45 Dogs With Distal Radial Osteosarcoma. A Veterinary Society of Surgical Oncology Retrospective Study.

OBJECTIVE To report outcomes in dogs with distal radial osteosarcoma (OSA) treated with metal endoprosthesis limb-sparing surgery and compare outcomes between 2 generations of endoprosthesis. STUDY DESIGN Multi-institutional retrospective case series. ANIMALS Forty-five dogs with distal radial OSA treated with endoprosthesis and chemotherapy. METHODS Data of dogs treated with either first-generation endoprosthesis (GEN1) or second-generation endoprosthesis (GEN2) were sourced from medical records and radiographs. Surgical outcomes included postoperative lameness assessment and the presence, severity, and time to onset of complications. Oncologic outcomes included presence of local recurrence or metastasis, time to onset of local recurrence, metastasis-free interval (MFI), and survival time. Results for surgical and oncologic outcomes were compared between GEN1 and GEN2. RESULTS Twenty-eight dogs received GEN1 and 17 dogs received GEN2. There were 39 complications (96%, 14 minor, 29 major) including infection (78%), implant-related complication (36%), and local recurrence (24%). Metastatic frequency was 67% and median MFI was 188 days (95% confidence interval [CI]: 126-250 days). Survival time ranged from 34 days to 6.1 years with a median of 289 days (95% CI: 207-371 days). There was no significant difference in complication severity, frequency, time to complication, MFI, or survival time between dogs receiving GEN1 and GEN2. CONCLUSION There was no significant difference in outcomes between dogs receiving GEN1 and GEN2 for limb-sparing surgery of the radius. Metastatic frequency and survival time for metal endoprosthesis were similar to that of amputation with curative intent chemotherapy.