Miracle-dz/UniFAR-FTUs huggingface dataset:
Outcome after iatrogenic esophageal perforation

Abstract Objectives: Iatrogenic perforations are the most common cause of esophageal perforation. We present our experience mainly based on a non-operative treatment approach as well as long-term outcome in these patients. Materials and methods: Twenty-one patients were treated for iatrogenic esophageal perforation at Oslo University Hospital, Ullevål from February 2007 to March 2014. The etiology of perforation was dilation of benign stricture in eight patients, either dilation, stenting or stent removal in four with malignant stenosis, during diagnostic endoscopy in four, removal of foreign body in two and by other causes in three patients, respectively. After median 82 months, 10 patients alive (47.6%) were sent questionnaires about dysphagia, HRQoL and fatigue. Results: Median age at time of treatment was 66 years. Median in-hospital stay and mortality were 10.5 days and 4.8%, respectively. Initial treatment in 15 patients (71.4%) was non-surgical of whom one needed delayed debridement for pleural empyema. Initial treatment in six patients (28.6%) was surgical of whom three needed delayed stenting. Altogether 14 patients (66.7%) were stented. Eight (57.1%) had restenting. Median number of stents used was 1 (1–4). The stents were removed after median 36 days. The perforations healed after 2.5 months. After median 82 months, the patients reported reduced HRQoL. There was no significant difference regarding level of dysphagia and fatigue. Conclusions: We report satisfactorily short-term and long-term results of iatrogenic esophageal perforations. Mortality was low and HRQoL was deteriorated. Dysphagia and fatigue were comparable to a reference population.
Police violence and the health of black infants

Analysis of 3.9 million birth records reveal spillover effects of police killings on the health of black infants. Police use of force is a controversial issue, but the broader consequences and spillover effects are not well understood. This study examines the impact of in utero exposure to police killings of unarmed blacks in the residential environment on black infants’ health. Using a preregistered, quasi-experimental design and data from 3.9 million birth records in California from 2007 to 2016, the findings show that police killings of unarmed blacks substantially decrease the birth weight and gestational age of black infants residing nearby. There is no discernible effect on white and Hispanic infants or for police killings of armed blacks and other race victims, suggesting that the effect reflects stress and anxiety related to perceived injustice and discrimination. Police violence thus has spillover effects on the health of newborn infants that contribute to enduring black-white disparities in infant health and the intergenerational transmission of disadvantage at the earliest stages of life.
Survival correlation of immune response in human cancers

Background: The clinical benefit of immune response is largely unknown. We systematically explored the correlation of immune response with patient outcome in human cancers. Results: The global immune gene signature was primarily located on the plasma membrane with a high gene density at 6p21 and 1q23-1q24. Immune responses varied with a wide range in human cancers. A total of 11 cancer types exhibited significant correlation of immune response with overall survival. Higher immune response was significantly associated with longer overall survival in 7 types and with shorter overall survival in 4 types. In addition, 11 cancer types exhibited significant correlation of immune response with progression-free interval. Higher immune response was significantly associated with longer progression-free interval in 7 types and with shorter progression-free interval in 4 types. Methods: The Ingenuity Knowledge Base and human genome assembly GRCh38 were used to annotate the immune gene signature by cellular components and genomic coordinates, respectively. We devised an mRNA-based metric of pre-existing immune conditions by using the gene signature, and calculated the metric for 10,062 The Cancer Genome Atlas tumor samples across 32 different cancer types. The Kaplan-Meier method was used to evaluate the overall survival and progression-free interval differences between dichotomic groups stratified by the median metric for each cancer type. Conclusions: Immune responses have different impacts on patient outcome in different human cancers. Prospective verification is needed before the findings can be applied for clinical trial development.
The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.
Discontinuation of first-line bevacizumab in metastatic colorectal cancer: the BEAWARE Italian Observational Study

Aims: BEAWARE investigated the pattern of first-line bevacizumab early interruption in the Italian real-world setting of metastatic colorectal cancer. Methods: A total of 386 patients were followed for 15 months after first-line chemotherapy + bevacizumab start. The rate of bevacizumab interruption for progression or adverse drug reactions (ADRs) constituted the primary endpoint. Results: A total of 78.2% of patients interrupted bevacizumab: 56.6% for progression, 7.3% for ADRs, and 36.1% for other reasons. Median treatment duration was 6.7, 2.5, and 4.6 months, respectively. Median progression-free survival was 10.3 months; however, 35.8% of patients were not progressed and were thus censored at the data cutoff of 15 months, while 21.8% were still receiving bevacizumab. Patients discontinuing for progression/ADRs more frequently had metastases in >1 site (p = .0001), and a shorter median progression-free survival (6.9 vs 13.9 months, p < .0001). Conclusions: In Italy, first-line bevacizumab is interrupted mainly for progression, only 7.3% due to adverse events, and about one third of cases for other reasons. In clinical practice, the attitude to treat until progression as per guidelines might be implemented. ClinicalTrials.gov Identifier: NCT01609075
Do Rotation and Measurement Methods Affect Reliability of Anterior Cruciate Ligament Tunnel Position on 3D Reconstructed Computed Tomography?

Background: The literature has seldom investigated the anterior cruciate ligament (ACL) tunnel position while considering the effect of rotation of 3-dimensional computed tomography (3D-CT) images during measurements. Hypothesis: We hypothesized that (1) measurement of the ACL tunnel position in the femur and tibia through use of 3D-CT is considerably influenced by rotation of the 3D model and (2) there exists a reliable measurement method for ACL tunnel position least affected by rotation. Study Design: Controlled laboratory study. Methods: The 3D-CT images of 30 randomly selected patients who underwent single-bundle ACL reconstruction were retrospectively reviewed. For femoral tunnel assessments, rectangular reference frames were used that involved the highest point of the intercondylar notch and outer margins of the lateral femoral condyle (method 1), the highest point of the intercondylar notch and outer margins of the lateral wall of the intercondylar notch (method 2), and the lowest point of the intercondylar notch and outer margins of the lateral femoral condyle (method 3). For tibial tunnel assessments, rectangular reference frames with the cortical outline at the articular surface of the tibia (method A) and the cortical outline of the proximal tibia (method B) were used. For both femoral and tibial assessments, the tunnel positions at 5°, 10°, and 15° of rotation of the 3D model were compared with that at a neutral position. Results: The values measured by methods 1 and 3 showed significant differences at greater than 5° of rotation compared with the value at the neutral position, whereas method 2 showed relatively consistent results. However, the values measured with both methods A and B showed significant differences at greater than 5° of rotation compared with the value at the neutral position. Conclusion: The tunnel position on 3D-CT images was significantly influenced by rotation during measurements. For femoral tunnel position, measurement with a reference frame using the lateral wall of the intercondylar notch (method 2) was the least affected by rotation, with relatively consistent results. Clinical Relevance: This study demonstrates that measurement using the lateral wall of the intercondylar notch might be a consistent and reliable method for evaluating the ACL femoral tunnel position considering the effect of 3D-CT image rotation during measurements. However, both methods to measure tibial tunnel position described in this study were similarly affected by rotation.
Evaluation of bacteriophage efficacy in reducing the impact of single and mixed infections with Escherichia coli and infectious bronchitis in chickens

ABSTRACT Infectious bronchitis virus (IBV) represents a major threat to poultry production worldwide particularly when complicated with bacterial infection. In the present study samples were collected from forty broiler farms with respiratory manifestations to characterize IBV and E. coli. Bacteriophages were isolated and enriched from sampled farms to study its efficacy to control single and mixed infections with E. coli and IBV in vivo. Twelve out of forty farms were positive for IBV. Phylogenetic analysis of partial spike protein revealed that all positive cases clustered within the GI-23 genotype. Eight out of forty farms were positive for E. coli serogroups O26, O78, O86, O114, O119, with O125 found on three farms. Bacteriophage treatment delayed the onset and reduced the severity of clinical signs, and prevented the mortality associated with single and mixed infection with IBV and E. coli. Furthermore, in mixed infections, bacteriophage treatment significantly reduced E. coli as well as IBV shedding. Groups treated with bacteriophages showed a significant reduction of E. coli shedding that gradually decreased over time, in contrast to higher and gradually increasing shedding without bacteriophage treatment. In conclusion, bacteriophage treatment significantly reduced the pathogenicity and shedding of IBVand E. coli in mixed infections.
Is multiple sclerosis progression associated with the HLA-DR15 haplotype?

Background The prevalence of multiple sclerosis is associated with the major histocompatibility complex class II DR15 haplotype HLA-DRB1*15:01∼HLA-DRB5*01:01. Objective To assess whether multiple sclerosis progression is associated with the main susceptibility haplotype HLA-DRB1*15:01∼HLA-DRB5*01:01. Methods Patients (n = 1230) and healthy controls (n = 2110) were genotyped for HLA-DRB1 and HLA-DRB5. The baseline Expanded Disability Status Scale (EDSS) score was determined and patients were followed for at least 3 years. Results After follow-up of the consecutive cohort 349 patients were classified as having clinical isolated syndrome and 881 patients as having multiple sclerosis. The susceptibility allele HLA-DRB1*15:01 was more frequent in clinical isolated syndrome (odds ratio 1.56) and multiple sclerosis (odds ratio 3.17) compared to controls. HLA- DRB1*15:01 was the only enriched HLA-DRB1 allele in multiple sclerosis patients. Comparison of clinical characteristics between HLA-DRB1*15:01∼HLA-DRB5*01:01 negative and positive patients with multiple sclerosis showed that baseline EDSS score, disease duration and frequency of the category secondary progressive multiple sclerosis with relapse were increased in the HLA-DRB1*15:01∼HLA-DRB5*01:01 positive group. Conclusion The study confirmed HLA-DRB1*15:01 and HLA-DRB5*01:01 as the main susceptibility alleles and showed weak indirect evidence for a role in progression of the disease.
Incidence and hemodynamic feature of risky esophageal varices with lower hepatic venous pressure gradient

Background: To examine the incidence of cirrhosis patients with high-risk esophageal varices (EV) who show hepatic venous pressure gradient (HVPG) < 10 mmHg and to identify their hemodynamic features. Methods: This prospective study consisted of 110 cirrhosis patients with EV, all with the candidate for primary or secondary prophylaxis. Sixty-one patients had red sign, and 49 patients were bleeders. All patients underwent both Doppler ultrasound and HVPG measurement. Results: There were 18 patients (16.4%) with HVPG < 10 mmHg. The presence of venous-venous communication (VVC) was more frequent in patients with HVPG < 10 mmHg (10/18) than in those with HVPG ≥ 10 mmHg (19/92; p = 0.0021). The flow volume in the left gastric vein (LGV) and the incidence of red sign were higher in the former (251.9 ± 150.6 mL/min; 16/18) than in the latter (181 ± 100.5 mL/min, p = 0.02; 45/92; p = 0.0018). The patients with red sign had lower HVPG (13.3 ± 4.5) but advanced LGV hemodynamics (velocity 13.2 ± 3.8 cm/s; flow volume 217.5 ± 126.6 mL/min), whereas those without red sign had higher HVPG (16.2 ± 4.6, p = 0.001) but poorer LGV hemodynamics (10.9 ± 2.3, p = 0.002; 160.1 ± 83.1, p = 0.02). Conclusion: Patients with high-risk EV with HVPG < 10 mmHg showed 16.4% incidence. Although low HVPG may be underestimated by the presence of VVC, the increased LGV hemodynamics compensates for the severity of portal hypertension, which may contribute to the development of red sign.
Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing (MORE-CRT MPP) study: results from Phase I.

AIMS To assess the impact of MultiPoint™ Pacing (MPP)-programmed according to the physician's discretion-in non-responders to standard biventricular pacing after 6 months. METHODS AND RESULTS The study enrolled 1921 patients receiving a quadripolar cardiac resynchronization therapy (CRT) system capable of MPP™ therapy. A core laboratory assessed echocardiography at baseline and 6 months and defined volumetric non-response to biventricular pacing as <15% reduction in left ventricular end-systolic volume (LVESV). Clinical sites randomized patients classified as non-responders in a 1:1 ratio to receive MPP (236 patients) or continued biventricular pacing (231 patients) for an additional 6 months and evaluated rate of conversion to echocardiographic response. Baseline characteristics of both groups were comparable. No difference was observed in non-responder to responder conversion rate between MPP and biventricular pacing (31.8% and 33.8%, P = 0.72). In the MPP arm, 68 (29%) patients received MPP programmed with a wide LV electrode anatomical separation (≥30 mm) and shortest LV1-LV2 and LV2-RV timing delays (MPP-AS); 168 (71%) patients received MPP programmed with other settings (MPP-Other). MPP-AS elicited a significantly higher non-responder conversion rate compared to MPP-Other (45.6% vs. 26.2%, P = 0.006) and a trend in a higher conversion rate compared to biventricular pacing (45.6% vs. 33.8%, P = 0.10). CONCLUSIONS After 6 months, investigator-discretionary MPP programming did not significantly increase echocardiographic response compared to biventricular pacing in CRT non-responders.
Percutaneous nephrolithotomy is safe and effective in aging male patients: a single center experience

Abstract Objective To assess the safety and effectiveness of percutaneous nephrolithotomy in aging male patients. Methods Two hundred eighty-three male patients over the years of forty undergoing percutaneous nephrolithotomy between December 2009 and September 2014 were evaluated, retrospectively. The patients were stratified by four age groups [40–49 (group-1), 50–59 (group-2), 60–69 (group-3), ≥70 years (group-4)]. The groups were compared regarding stone size, mean operation time, mean access number, mean nephrostomy removal time, hospitalization duration, stone-free rate, and complications rate. The patients were also evaluated with regard to glomerular filtration rate levels preoperatively and in the sixth month after surgery. Results Mean stone size was 810 ± 490 mm2 in group-1, 840 ± 500 mm2 in group-2, 845 ± 480 mm2 in group-3, and 800 ± 460 mm2 in group-4 (p = .02). There was no statistical difference between the four groups in terms of mean operation time, access number, hemorrhage, nephrostomy removal time, and hospital stay duration (p > .05). After additional interventions; no significant difference was detected for final stone-free rates among the groups (p = .12). A significant improvement was detected in glomerular filtration rate levels in the sixth month after surgery in all groups (p < .05). Conclusion These results indicate that percutaneous nephrolithotomy is a safe and effective method in aging male patients.
An achievable rate for the multiple level relay channel

This paper proposes a new coding scheme and proved a new achievable rate formula for the Gaussian case. The scheme is simpler and avoids some inconvenient techniques (e.g., the Slepian-Wolf partitioning), in giving the same achievable rate for the single relay case. More importantly, this new coding scheme is easier to extend to the multiple level relay case, and generally achieves higher rates. Here we present the results for the discrete memoryless case. The paper also goes on to obtain the capacity of some relay channels under fading, which is the first significant capacity result for such channels, and one, which may possibly constitute a breakthrough in the field.
Sleep-Disordered Breathing in Hospitalized Geriatric Patients with Mild Dementia and Its Association with Cognition, Emotion and Mobility

Sleep-disordered breathing (SDB) is an emerging dementia risk factor. Data on the prevalence of SDB in dementia patients and its association with cognitive impairment is so far only based on patients with severe dementia. In 101 geriatric patients mostly with mild dementia recruited on German geriatric wards, SDB was assessed during overnight polygraphy in the patient room with a portable sleep apnea examination device and associations of SDB severity with severity of impairment in cognitive and emotional function as well as mobility were investigated. We also elucidated which factors influence compliance of SDB diagnostics. In 82 of the 101 dementia patients (81.2%), SDB could be assessed. Of those, only 12.2% had an apnea-hypopnea index (AHI) < 5/h demonstrating the absence of SDB. 40.2% exhibited 5/h ≤ AHI < 15/h representing mild SDB, and 47.6% revealed an AHI ≥ 15/h representing moderate/severe SDB. Patients in these three AHI categories did not significant differ from each other in demographical and clinical characteristics. Patients with an AHI ≥ 15/h particularly often presented with heart failure and vitamin D deficiency. We observed a low to moderate association between severity of SDB and severity of dementia. Tolerance of the nasal airflow sensor of at least 6 h was present in less than one third of all patients. The tolerant group exhibited more symptoms of depression and higher physical fitness compared to the non-tolerant group. We observed a high prevalence of SDB also in geriatric patients with mild dementia underlining the importance of SDB screening in the elderly.
Transcatheter aortic valve replacement: Protect the kidneys to protect the patient

Transcatheter aortic valve replacement (TAVR) seems superior to surgical aortic valve replacement (SAVR) for intermediate‐term outcomes in patients with aortic stenosis and moderate to severe chronic kidney disease (CKD). Intermediate‐term mortality and the major adverse cardiac and renal event increase if the renal function worsens soon after TAVR or SAVR. Patient's demographic profile, comorbid conditions, and procedural characteristics influence the clinical outcomes emphasizing the need for careful risk assessment in deciding TAVR versus SAVR in CKD patient.
Alternate-Day Low Energy Availability During Spring Classics in Professional Cyclists.

PURPOSE: To assess energy and carbohydrate availability and changes in blood hormones in 6 professional male cyclists over multiple single-day races. METHODS: We collected weighed food records, powermeter data and morning body mass across 8 days. Carbohydrate intakes were compared to contemporary guidelines. Energy availability (EA) was calculated as energy intake minus exercise energy expenditure, relative to fat-free mas (FFM). Skinfold thickness and blood metabolic and reproductive hormones were measured pre- and post-study. Statistical significance was defined as p≤0.05. RESULTS. BM (p=0.11) or skinfold thickness (p=0.75) did not change across time, despite alternate-day low EA (14±9 vs 57±10 kcal·kg FFM·d-1, race vs rest days, respectively; p<0.001). Cyclists with extremely low EA on race days (<10 kcal·kg FFM·d-1; n=2) experienced a trend towards decreased testosterone (-14%) and insulin-like growth-factor-1 (-25%), despite high EA (>46 kcal·kg FFM·d-1) on days in-between. Carbohydrate intakes were significantly higher on race vs rest days (10.7±1.3 vs 6.4±0.8 g·kg·d-1, respectively;p<0.001). The cyclists reached contemporary pre-race fueling targets (3.4±0.7 g·kg·3h-1 carbohydrates; p=0.24), while the execution of CHO guidelines during race (51±9 g·h-1; p=0.048) and within acute (1.6±0.5 g·kg·3h-1; p=0.002) and prolonged (7.4±1.0 g·kg·24h-1; p=0.002) post-race recovery was poor. CONCLUSIONS: We are the first to report day-by-day periodization of energy and carbohydrate in a small sample of professional cyclists. We have also examined the logistics of conducting a field study under stressful conditions in which major cooperation of subjects and team management is needed. Our commentary around these challenges and possible solutions is a major novelty of the paper.