Miracle-dz/UniFAR-FTUs huggingface dataset:
Improved cartilage regeneration by implantation of acellular biomaterials after bone marrow stimulation: a systematic review and meta-analysis of animal studies

Microfracture surgery may be applied to treat cartilage defects. During the procedure the subchondral bone is penetrated, allowing bone marrow-derived mesenchymal stem cells to migrate towards the defect site and form new cartilage tissue. Microfracture surgery generally results in the formation of mechanically inferior fibrocartilage. As a result, this technique offers only temporary clinical improvement. Tissue engineering and regenerative medicine may improve the outcome of microfracture surgery. Filling the subchondral defect with a biomaterial may provide a template for the formation of new hyaline cartilage tissue. In this study, a systematic review and meta-analysis were performed to assess the current evidence for the efficacy of cartilage regeneration in preclinical models using acellular biomaterials implanted after marrow stimulating techniques (microfracturing and subchondral drilling) compared to the natural healing response of defects. The review aims to provide new insights into the most effective biomaterials, to provide an overview of currently existing knowledge, and to identify potential lacunae in current studies to direct future research. A comprehensive search was systematically performed in PubMed and EMBASE (via OvidSP) using search terms related to tissue engineering, cartilage and animals. Primary studies in which acellular biomaterials were implanted in osteochondral defects in the knee or ankle joint in healthy animals were included and study characteristics tabulated (283 studies out of 6,688 studies found). For studies comparing non-treated empty defects to defects containing implanted biomaterials and using semi-quantitative histology as outcome measure, the risk of bias (135 studies) was assessed and outcome data were collected for meta-analysis (151 studies). Random-effects meta-analyses were performed, using cartilage regeneration as outcome measure on an absolute 0–100% scale. Implantation of acellular biomaterials significantly improved cartilage regeneration by 15.6% compared to non-treated empty defect controls. The addition of biologics to biomaterials significantly improved cartilage regeneration by 7.6% compared to control biomaterials. No significant differences were found between biomaterials from natural or synthetic origin or between scaffolds, hydrogels and blends. No noticeable differences were found in outcome between animal models. The risk of bias assessment indicated poor reporting for the majority of studies, impeding an assessment of the actual risk of bias. In conclusion, implantation of biomaterials in osteochondral defects improves cartilage regeneration compared to natural healing, which is further improved by the incorporation of biologics.
Preenchimento da Lista de Verificação de Segurança Cirúrgica em hospitais brasileiros

Objective: analyzing the scientific evidence about the frequency of checking items on the Surgical Safety Checklist in Brazilian hospitals. Methods: integrative review. The databases used: Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieve System Online, Spanish Librarian Index of Health Sciences, Nursing Database, National Medical Sciences Information Center of Cuba, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature. The search occurred in January 2018, combining the descriptors: patient safety, surgical centers, surgical rooms, operative surgical procedures and checklist. Results: in spite of the great variation of the frequency of the items checking, the majority presented low gauging, with an average lower than 80.0%. The best verification was observed in the first stage of the instrument. Conclusion: the frequency of the checking was unsatisfactory, evincing the need for improvements, based on the safety culture of the surgical patient.
Autologous platelet injection in the treatment of long bone nonunion: A prospective interventional study

Introduction: Union of fracture is a complex process involving many systemic as well as local factors. Disturbance in any of these factors may lead to failure of process of union. This non-union is associated with increased morbidity, pain and functional disability. Autologous platelet injection at local site has been reported to be one of the effective measures in managing the cases of fracture of long bones complicated by non-union. We conducted this prospective study to know the effectiveness of autologous platelet injection at the fracture site in cases of fracture of long bones complicated by non-union. Materials and Methods: This was a prospective interventional study comprising of 30 cases of fracture of long bones complicated by non-union. The patients were included in this study on the basis of a predefined inclusion and exclusion criteria. The patients with established nonunion after fracture femur, tibia, humerus, radius and ulna were included in this study. Patients who were treated either by, by internal fixation, bone grafting or conservatively were added in this study. Imaging was done by X-rays and if needed by computerized tomography. Imaging was done till definite evidence of union was obtained. Results: Out of 30 cases there were 18 males and 12 females with a M:F ratio of 0.66. The most common bones involved were femur (60%), tibia (16.67%) and humerus (16.67%). Combined fractures of Radius and Ulna were seen in 3 (10 %) patients. The mechanism of injury was Road traffic accidents (66.66%) followed by direct blow and fall from height. All patients initially were treated conservatively or by surgery depending upon type of fractures. Non-union of fractures were treated by autologous platelet injection. All fractures showed radiological evidence of union within 4 months of treatment. Conclusion: Autologous platelet injection at local site is an effective management strategy in patients of fracture of long bones complicated by non-union. A non-infected site is the pre-requisite of this treatment.
Exogenous hormone use and cutaneous melanoma risk in women: The European Prospective Investigation into Cancer and Nutrition

Evidence suggests an influence of sex hormones on cutaneous melanoma risk, but epidemiologic findings are conflicting. We examined the associations between use of oral contraceptives (OCs) and menopausal hormone therapy (MHT) and melanoma risk in women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a prospective cohort study initiated in 1992 in 10 European countries. Information on exogenous hormone use at baseline was derived from country‐specific self‐administered questionnaires. We used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Over 1992–2015, 1,696 melanoma cases were identified among 334,483 women, whereof 770 cases among 134,758 postmenopausal women. There was a positive, borderline‐significant association between OC use and melanoma risk (HR = 1.12, 95% CI = 1.00–1.26), with no detected heterogeneity across countries (phomogeneity = 0.42). This risk increased linearly with duration of use (ptrend = 0.01). Among postmenopausal women, ever use of MHT was associated with a nonsignificant increase in melanoma risk overall (HR = 1.14, 95% CI = 0.97–1.43), which was heterogeneous across countries (phomogeneity = 0.05). Our findings do not support a strong and direct association between exogenous hormone use and melanoma risk. In order to better understand these relations, further research should be performed using prospectively collected data including detailed information on types of hormone, and on sun exposure, which may act as an important confounder or effect modifier on these relations.
A positron emission tomography study of the functional neuroanatomy of closed head injury

Structural changes in the frontal and temporal lobes and in subcortical white matter tracts often occur following closed head injury (CHI)In contrast to this well delineated structural pathology, the post-traumatic cognitively-related functional changes in these and other brain regions have not been adequately described. To characterize the long-term functional neuroanatomy of CHI, the present study compared regional cerebral blood flow (rCBF) patterns in 13 severely-injured, well-recovered, unmedicated patients to those from 13 well-matched healthy controls. rCBF was measured using oxygen-15 water intravenous bolus positron emission tomography (PET) while subjects performed the Wisconsin Card Sorting Test (WCST), an indicator of prefrontal lobe functioning that involves matching stimuli to a changing sorting principle based on external feedback, and a Cued Recall Memory Test (CRMT), which involves remembering semantically-related word pairs. The neuropsychological tasks were used to provoke specific neural systems believed to be important in task performance (the prefrontal cortex in the former, the hippocampus in the latter). Subjects also performed two specially designed sensorimotor control tasks to provide measures of baseline rCBF. Given the controversy regarding the statistical analysis of PET data, a two­ pronged method was utilized: 1) Statistical Parametric Mapping, the state-of-the-art technique that examines rCBF throughout the entire brain, and 2) region of interest
Hypothalamic hamartomas and Gelastic seizures. Chilean experience in a pediatric epilepsy surgery program during 13 years - Review of the literature

Hypothalamic Hamartomas (HH) are benign tumors consist of hyperplastic heterotopic tissue growing in a disorganized fashion. They are associated to epilepsy usually refractory to medical treatment. The classical description of seizures are “Gelastic”, however HH can produce different types of focal seizures or even generalized symptoms. Objectives: To determine the pre surgical aspects as well as operative techniques with the best outcomes in HH associated to gelastic seizures and epilepsy refractory to medical treatment. Methods: We studied pediatric patients with HH who underwent Epilepsy surgery between 2004 and 2017. It was analyzed the type of seizures before surgery, the neurological comorbidity, the type of hamartoma seen in MRI, the electroencephalography records and the type of surgery and outcome according to the Engel’s and ILAE’s classification. Also we compare the neuropsychological evaluation before and after surgery. Conclusions: Indistinctly of the open surgery technique used, the possibility to remove the totality of the tumor was only 14%. Nonetheless the results evaluated with ILAE’s and Engel’s outcome score were not so bad, possibly because the surgery gets the splitting of the hamartoma from the rest of the hypothalamus. Biography: Maximiliano Paez Nova MD. is a neurosurgeon graduated from the Pontificia Universidad Javeriana in Bogota (Colombia), his neurosurgical life has been dedicated to the Epilepsy surgery and functional neurosurgery. He performed his subspecialty in Epilepsy surgery in National Autonomous University of Mexico, National Neurosurgery and Neurology Institute” Manuel Velasco Suarez", Mexico; being alumni from Prof. Mario Alonso Vanegas recognized Epilepsy surgeon in America. Then, motivated by the SEEG decided to perform his fellowship in Functional neurosurgery beside one of the most known experienced professors in this area in the world Prof. Paresh Doshi in Mumbai, India and with Prof. Takaomi Taira at Tokyo Women's Medical University, Japan. His particular emphasis in pediatric epilepsy and abnormal movements disorders in pediatric population motivated him to perform a fellowship in Pediatric neurosurgery in the famous “Dr. Asenjo” Neurosurgical Institute in Santiago de Chile, under the tutorial of Prof. Sergio Valenzuela. 26 World Congress on Neurology and Neurodisorders, 2020 August 26-27, 2020
Aspectos da sobrecarga e qualidade de vida de cuidadores de pacientes hospitalizados: uma análise baseada na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF)

Resumo Objetivo: caracterizar o perfil e a relação entre sobrecarga e qualidade de vida (QV) de cuidadores de pacientes hospitalizados de acordo com o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Analisar a correlação entre a sobrecarga do cuidador e o nível de dependência motora e cognitiva do paciente. Métodos: estudo transversal com 68 cuidadores de pacientes hospitalizados há 12 ou mais dias. Para avaliação da QV e da sobrecarga dos cuidadores foram utilizados, respectivamente, o Short Form Health Survey (SF-36) e a escala de Zarit (Zarit Burden Interview). Utilizou-se a Medida de Independência Funcional para caracterizar a dependência motora e cognitiva dos pacientes. Os resultados foram relacionados aos conceitos da CIF. Resultados: de acordo com os qualificadores da CIF, um comprometimento progressivo na QV dos cuidadores foi observado com o aumento da sobrecarga. Houve correlação negativa, estatisticamente significante e de fraca magnitude, entre a percepção de QV e sobrecarga. Não houve correlação entre a sobrecarga do cuidador e o nível de dependência do paciente. Conclusão: o SF-36 é capaz de analisar 13 categorias da CIF, permitindo avaliar o cuidador de forma integral, de acordo com o modelo biopsicossocial, e facilitando o uso da CIF na prática clínica.
Experienced Practitioners' Views on Interpersonal Skills in Telehealth Delivery

Background. As telehealth becomes a larger part of the health care landscape, clinicians are becoming prepared to operate technology-based­ systems for conducting routine care and exchanging information. Less defined are interpersonal skills for telehealth care delivery such as communication and therapeutic relationships that can influence clinical outcomes. Examples include clinician adaptability to the communication process via telehealth, clinician congeniality in communications, and striving to achieve telepresence. The purpose of this study was to describe interpersonal skills for telehealth delivery to assist in the preparation of health professionals. Methods. Aqualitative methods approached was used to build on results from our previously published systematic review. Semi-structured, in-depth interviews were conducted with experienced practitioners or educators (n=6) at multiple regional telehealth centers. Video/audio-recorded sessions were transcribed verbatim and researchers conducted thematic analysis of data until achieving saturation of data. Results. Participants provided their perspectives about interpersonal skills important for quality telehealth delivery based on professional experiences. Analysis of responses across interviews showed strong alignment with the six themes identified previously as non-technical clinician attributes: Preinteractional, Verbal Communication, Non-Verbal Communication, Relational, and Environmental. Also, an additional theme of Management/Operations emerged. Suggested training topics crossed clinical disciplines and ranged from telemedicine etiquette and verbal skills to equipment operation and billing and coding. Each study participant commented on benefits from preparation of telehealth clinicians related to the clinician-patient interaction such as: patient engagement, patient-centered care, patient satisfaction, patient implementation of care plans, effective communication with patients, and quality assessment of telehealth sessions. Conclusions. This study identified interpersonal skills that may be applied in professional education for telehealth delivery from the perspective of experienced practitioners. Further research could explore outcomes from professional preparation for interpersonal skills and patient perspectives.
Loading in an Upright Tilting Hospital Bed Elicits Minimal Muscle Activation in Healthy Adults

Purpose: Upright tilting hospital beds (THB) are used during early rehabilitation of critically ill patients. Tilting patients in a THB to achieve weight-bearing or loading is purported to mitigate the response of prolonged immobility associated with critical illness. The primary aim of this study is to determine the level of muscle activation during loading in a THB and secondarily to assess whether safety straps influence the level of muscle activation. Methods: Quasi-experimental design in a musculoskeletal laboratory. Nineteen healthy community-dwelling adults with no prior neuromuscular disorder were included. Two groups, 10 subjects with straps-on and 9 subjects with straps-off, were tilted in a THB through 9 intervals of 10° (0°-80°). Muscle activation was recorded using surface electromyography in tibialis anterior, rectus femoris, gluteus medius, and lumbar erector spinae muscles. Raw and electromyography-normalized data were analyzed across angles and conditions. Loading (weight-bearing) was recorded using the THB footplate scale. Results: Electromyographic activity in the tibialis anterior, rectus femoris, gluteus medius, and lumbar erector spinae muscles was minimal as the angle of tilt and loading increased. No statistically significant increases compared with supine rest were observed, except rectus femoris muscle activation at 60° in the groups without straps (P = .023). Similarly, only muscle activation in the rectus femoris was higher in the group without straps from angles 40° to 80° than in the group with straps. Conclusion: Relaxed, gravity-facilitated loading in a THB elicits minimal muscle activation in healthy subjects and, therefore, passive loading's usefulness for enhancing muscle strength is questioned. Removal of safety straps did lead to increased muscle activation in the rectus femoris; this concept should be explored further to understand whether location of the straps, tightness of the straps, and/or the angle of the hip and knee joints during loading could hamper muscle activation.
Myocardial perfusion SPECT and SPECT/CT in interventional cardiology

Myocardial perfusion imaging with single‐photon emission computed tomography (SPECT) is an important and widely used non‐invasive imaging test for the diagnosis and semiquantification of myocardial ischemia. SPECT data, acquired after a stress test and at rest on a gamma camera, shows left ventricular tracer uptake during stress and at rest. The tracer distributions are proportionate to the relative, regional coronary‐flow distributions, respectively. A stress‐induced perfusion defect reflects myocardial ischemia, while a permanent defect, unchanged from stress to rest, indicates myocardial infarction. By ECG‐gating global and regional left ventricular function can also be assessed. The three most important indications for SPECT in the setting of interventional cardiology include (1) the diagnosis of coronary artery disease in intermediate‐risk patients, (2) the assessment of ischemia in patients with prior successful revascularization and recurrence of symptoms, and (3) the diagnosis of acute coronary syndrome in the emergency department. The amount of ischemia is related to the outcome of patients undergoing revascularization. It was observed that patients with an ischemic area of <10% of the left ventricle demonstrated by SPECT benefit from staying on optimal medical therapy, whereas patients with more ischemia on SPECT benefit from revascularization. Guidelines and appropriate use criteria for the indications of SPECT in relation to interventional cardiology have been published by the European Society and American College of Cardiology.
A Critical Reevaluation of the Intraluminal Thread Model of Focal Cerebral Ischemia

Background and Purpose—The intraluminal thread model for middle cerebral artery occlusion (MCAO) has gained increasing acceptance. Numerous modifications have been reported in the literature, indicating that the technique has not been standardized. The present study was performed to evaluate and optimize the reliability of this model. Methods—One hundred Sprague-Dawley rats were subjected to MCAO by 2 different intraluminal filaments. Cortical blood flow was continuously monitored over both hemispheres by laser-Doppler flowmetry (LDF). In part I (3-0 filament), we evaluated the incidence of adequate MCAO, subarachnoid hemorrhage (SAH), intraluminal thrombus formation, and the effects of heparinization. In part II (silicone-coated 4-0 filament), we also determined the influence of insufficient MCAO on morphological and functional outcome and the incidence of postischemic hyperthermia. Results—In part I, SAH occurred in 30% and premature reperfusion in 24%. All animals with a decrease in contralateral flow .
PAP smear in pregnancy: a hospital-based study

Background: Pregnant and non-pregnant women are at similar risk for CIN and cervical cancer. The incidence of abnormal cervical cytologic findings during pregnancy is 0.72 to 1.67%. Approximately 86% of all squamous intraepithelial lesions (SIL) indentified during pregnancy are classified as low-grade SIL, whereas 14% are high- grade SIL. The aim of this study is to assess the incidence of Pap smear abnormalities among antenatal woman presenting to present hospital.Methods: A prospective study was conducted in present medical college hospital in the department of Obstetrics and Gynecology for a period of one year from Jan 2017 to Dec 2017. A total of 200 antenatal women were included in the study. Ayre’s spatula was used to conduct smear tests in this study. All smears were immediately sprayed with a fixative and sent to the department of Pathology. The cytological results were reported based on the Bethesda classification system 2001.Results: The pap smear report revealed that 26% of the subjects had inflammatory changes and for 66% it showed negative for intraepithelial lesion and for only 1% of the subjects had signs related to carcinoma cervix in which one patient had Atypical Squamous Cell of Undetermined Significance (ASCUS) and another patient had Low-grade Squamous Intraepithelial Lesion (LSIL) and no satisfactory sample was able to be obtained in 6% of the subjects. In present study authors found a statistically significant association between the age at marriage and the pap smear report, lower the age at marriage (<20 years) higher the incidence of inflammatory changes in the cervix and both the patients who were reported with ASCUS and LSIL were in the age of 15 and 16 years respectively.Conclusions: Clinicians should make every effort to educate, counsel and screen pregnant women if they have not had a Pap test in the past.