Miracle-dz/UniFAR-FTUs huggingface dataset:
Coronary Artery Bypass Grafting - Postoperative Employment and 20-year Mortality : Impact of Obesity, Metabolic Syndrome and Diabetes Mellitus

Objectives To establish which factors influence patients’ return to work and how well they remain at work after coronary artery bypass grafting (CABG). Design 569 consecutive CABG patients aged less than 65 years were followed for 10 years. Data were collected from patient records and by questionnaires supplemented with information from Finnish national archives. Results Multivariate analysis showed the best predictors for return to work to be younger age, preoperative working, as well as absence of diabetes or perioperative cardiac damage. Almost half of the patients aged less than 60 and preoperatively not retired were working one year after CABG. Five years postoperatively, 85% of patients younger than 60 years and once returned to work were still working. Correspondingly, of subjects remaining under 60 years during a 10-year follow-up, 75% continued working. Conclusions Younger age and preoperative employment were the most important predictors of successful return to work. Once returned after CABG, patients’ staying at work was comparable with that in the general population.
İnsülin Benzeri Büyüme Faktörü-1 ve Premature Morbiditeleri: Bronkopulmoner Displazi, Premature Retinopatisi, İntraventriküler Kanama ve Nekrotizan Enterokolit

GIRIŞ ve AMAC: Insulin benzeri buyume faktoru-1 (IGF-1) fetal ve postnatal donemde etkili onemli bir buyume faktorudur. Premature dogum sonrasi serum IGF-1 duzeyleri hizlica dusmekte intrauterin donemden daha da dusuk seviyelerde kalabilmektedir. Bu calismada serum IGF-1 duzeylerinin, bronkopulmoner displazi (BPD), premature retinopatisi (PR), intraventrikuler kanama (IVK) ve nekrotizan enterokolit (NEK) gibi premature morbiditeleri ile iliskisinin olup olmadigi ve morbiditeleri on gormede belirtec olarak kullanip kullanilamayacagi arastirilmistir. YONTEM ve GERECLER: Bu ileriye yonelik, gozlemsel calismaya, dogum yasi ≤32 hafta olan premature bebekler alindi. Bebeklerin yasamlarin 1, 3, 7, 21 ve 28. gunlerinde serum IGF-1 duzeyleri olculdu. Neonatal morbiditeler acisindan izlemleri yapildi. BULGULAR: Calismaya toplam 93 bebek alindi. Bebeklerin ortalama dogum agirligi 1236,11±354,06 gr, ortalama dogum yaslari 29,43±2,10 hafta idi. BPD ve PR gelisen bebeklerin serum IGF-1 degerleri, gelismeyenlere gore anlamli olarak dusuk saptandi. IVK ve NEK gelisen hastalarda ise IGF-1 duzeyleri acisindan gelismeyenlere gore anlamli fark saptanmadi. TARTIŞMA ve SONUC: Premature bebeklerde BPD ve PR gelisimi ile ilk 4 haftadaki dusuk IGF-1 duzeyleri arasinda belirgin iliski mevcuttur.
The impact of obesity on the short-term efficacy of inter sphincteric resection for patients with ultra-low rectal or anal canal cancer

Aim: To determine whether obesity has an impact on the short-term efficacy of inter sphincteric resection (ISR) for patients with ultra-low rectal or anal canal cancer. Methods: This retrospective study includes 276 patients with rectal or anal canal cancer who received treatment from the Rectal Surgery Group of the Gastrointestinal Surgery Center of West China Hospital. According to the WHO, the overweight has a BMI greater than 25. We compare the intraoperative related indicators, postoperative recovery indicators and the rate of occurrence of complications between Group A and Group B. Results: The time of operation in Group B is apparently longer than that in Group A (143.41 min VS. 130.91 min P < 0.05), the intraoperative blood loss, the anastomotic patterns and the reconstruction pattern are not statistically different. The rate of perianal infection of Group B is significantly higher than that of Group A (6.5% VS. 1.5% P < 0.05), and the rate of incision infection of Group B is significantly higher than that of Group A (5.6% VS. 0.6% P < 0.05). The rate of occurrence of other complications between two groups is not statistically different. Conclusion: Obesity increases the difficulty of performing ISR for ultra-low rectal or anal canal cancers, extends the time of operation, and increases the incidence rate of perianal infection post-operatively. There is no significant difference between the indications of postoperative recovery, and the incidence rate of complications in obese patients and that in normal weight patients. In terms of the short-term effects, the operations for obese patients are safe and effective. *Correspondence to: LI L, Way-nan Guo-Xue Xiang 37#, Chengdu, Sichuan, 610041, China, Tel: 86-18980601487; E-mail: drlili116@126.com
Proposal for an Organ-Specific Chronic Inflammation–Remodeling–Carcinoma Sequence

An organ-specific chronic inflammation–remodeling–carcinoma sequence has been proposed, mainly for the alimentary tract. As representative diseases, gastroesophageal reflux disease, chronic gastritis and inflammatory bowel disease (ulcerative colitis and Crohn’s disease of the colitis type) were adopted for this discussion. Tissue remodeling is such an important part of tumorigenesis in this sequence that an organ-specific chronic inflammation–remodeling–carcinoma sequence has been proposed in detail. Chronic inflammation accelerates the cycle of tissue injury and regeneration; in other words, cell necrosis (or apoptosis) and proliferation result in tissue remodeling in long-standing cases of inflammation. Remodeling encompasses epithelial cell metaplasia and stromal fibrosis, and modifies epithelial–stromal cell interactions. Further, the accumulation of genetic, epigenetic and molecular changes—as well as morphologic disorganization—also occurs during tissue remodeling. The expression of mucosal tissue adapted to chronic inflammatory injury is thought to occur at an early stage. Subsequently, dysplasia and carcinoma develop on a background of remodeling due to continuous, active inflammation. Accordingly, organ-specific chronic inflammation should be ameliorated or well controlled with appropriate monitoring if complete healing is unachievable.
Chronic Lymphocytic Leukemia

The MURANO study was a phase 3 study comparing venetoclax- rituximab (VenR) with BR in relapsed/refractory CLL. After a median follow-up of 3 years, PFS and OS were found to be superior in the VenR group compared to the BR group (HR, 0.16 [95% CI, 0.12 to 0.23]; and HR, 0.50 [95% CI, 0.30 to 0.85], respectively). 42 VenR patients reached a higher rate of peripheral blood (PB) undetectable minimal residual disease (uMRD) at the end of combination therapy (62% vs 13%), which prognosticated a longer PFS. These results were seen across all subgroups, and validate the previously reported MURANO study findings. 43 Follow-up data has demonstrated superior 4-year PFS and OS rates for VenR compared to BR. 44 The 4-year PFS was 57.3% vs. 4.6% (HR: 0.19; 95%CI: 0.14-0.25) for VenR vs. BR, and 4-year OS was 85.3% vs 66.8% (HR: 0.41; 95%CI: 0.26-0.65), respectively. Further updated 5-year survival data was presented at the ETA 2021 conference, and reported OS of 82.1% in the VenR arm compared to 62.2% in the in the BR arm. 45
Gall stone pancreatitis in a syringomyelia patient: case report and historical review

Syringomyelia is a rare neurological disorder generally regarded as chronic, characterized by slowly progressing fluid-filled cyst (syrinx) forms within the spinal cord. Here we describe the historical review of a patient suffering from syringomyelia for the past 16 years and present gastric condition- gall stone induced pancreatitis. A quadriparetic female patient who had previously undergone surgical treatment for syringomyelia with the early signs including muscle weakness and wasting (atrophy), loss of reflexes, loss of sensitivity to pain and temperature and also stiffness in back, shoulders, spinal curvature (scoliosis) presenting complains of multiple episodes of hematemesis and severe constipation since 5 days. Ultrasonography imaging and laboratory investigations revealed gallbladder stone induced acute pancreatitis also associated. The patient underwent multiple surgical interventions for syrinx removal and associated surgical complications were managed adequately. Currently, the pancreatitis was managed by laparoscopic corrections. Postoperatively, there was a prompt resolution of pancreatitis and associated gastric symptoms. In conclusion, early diagnosis of syringomyelia with magnetic resonance imaging is critical in the prophylaxis of spinal cord compression and potential neurologic injury. Surgical interventions are recommended in symptomatic cases. This case report describes clinical manifestations and management of acute pancreatitis in a chronic sufferer of syringomyelia.
A Case of Cleidocranial Dysplasia with a Novel Mutation and Growth Velocity Gain with Growth Hormone Treatment

Cleidocranial dysplasia (CCD) is a rare congenital autosomal dominant skeletal disorder that is characterized by hypoplasia or aplasia of clavicles, failure of cranial suture closure, dental anomalies, short stature and other changes in skeletal patterning and growth. The gene responsible for pathogenesis has been mapped to the short arm of chromosome 6p21, core binding factor alpha-1 (CBFA1) or runt related transcription factor-2 (RUNX2). Here we describe a CCD patient with a novel mutation in the RUNX2 gene. A five-and-a-half year old girl presented with severe short stature, dysmorphic facial appearance (hypertelorism, prominent forehead, high palate, midfacial hypoplasia), macrocephaly, large anterior fontanelle, increased anteroposterior chest diameter. Her shoulders were close to each other and her bilateral clavicles appeared short on physical examination. Bilateral hypoplastic clavicles, coxa valga, hypoplasia of iliac bones, wide symphysis pubis and phalangeal dysplastic features were detected on her skeletal X-ray examination. She was diagnosed as having CCD. Molecular analysis detected a novel heterozygous mutation ‘NM_001024630. 3p.T155P(c.463A>C)’ in the RUNX2 gene. At age seven years and two months old, because of her severe short stature, growth hormone (GH) treatment was started and she responded well to GH therapy with no adverse effects. In conclusion, hypoplasia or aplasia of the clavicles, failure of cranial suture closure, dental anomalies and short stature should bring CCD to mind. We present a novel mutation in the RUNX2 gene for CCD. We obtained growth velocity gain with GH treatment in our patient.
Aromatherapy with Iranian Herbal Medicines for Premenstrual Syndrome and Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Background: Primary dysmenorrhea is painful bleeding in the absence of any confirmed pelvic disorder, which is often accompanied by nausea, vomiting, and headache. The tendency of patients to use herbal and alternative medicine is more than the past. Regarding the fact that no meta-analytical study has been done to evaluate aromatherapy with Iranian herbal medicines, this study was conducted to evaluate the effect of aromatherapy with different herbs on premenstrual syndrome andprimary dysmenorrhea. Materials and Methods: English and Persian electronic databases were systematically searched without any time limit until May 5, 2019. The references of review articles and clinical trials were also reviewed. Two authors independently reviewed the titles and abstracts, if the subject of the article was relevant, the full article was extracted and criticized. Comprehensive Meta-Analysis software was used to conduct meta-analysis. Results: Finally, 14 studies were entered into a meta-analysis. The mean standard difference between two groups of aromatherapy with different plants and control group was -1.06 (95%CI: -1.33 to -0.848; p<0.001). Aromatherapy with roses (SMD=-1.35; 95%CI= -0.01 to -2.69; p=0.048), and aromatherapy with lavender (SMD= -1.08; 95% CI: -0.73 to -1.43; p<0.001) compared to the control group had better effect in reduction of pain severity. According to three studies, aromatherapy with Geranium 2% essential oil, Citrus aurantium blossom essential oil, and Rosa damascena were more effective than control group regarding mental and physical signs. Conclusion This meta-analysis showed that aromatherapy with different Iranian herbs such as lavender and rose could significantly reduce primary dysmenorrhea and premenstrual syndrome. This treatment can be used specifically in patients who cannot tolerate conventional treatments.
Effect of tobacco control policies on intention to quit smoking cigarettes: A study from Beirut, Lebanon

INTRODUCTION In Lebanon, the tobacco control policy, Law 174, became effective in 2011. Using the International Tobacco Control Policy Evaluation Project (ITC) conceptual model, this study aims to assess the association between exposure to control measures related to the policy and the intention to quit, which is a mediator in the pathway leading to behavioral change (quitting). METHODS This is a secondary data analysis of 154 cigarette smokers from a cross-sectional survey that assessed compliance with Law 174 among Beirut residents aged 15–65 years. Data were collected face-to-face, three months after the implementation of indoor public places and tobacco advertisement/promotion bans. Intention to quit smoking was the main outcome. Exposure to policy control measures such as seeing smokers in restaurants, and noticing warning labels on cigarette packs were the explanatory variables. Sociodemographics, past smoking behavior, and psychosocial variables were also considered for their moderating and mediating effects, respectively. Crude and adjusted odds ratios (ORs) were generated. Sobel test was used to check for possible mediation. RESULTS Intention to quit was reported by 24% of cigarette smokers. The association between noticing warning labels and having intentions to quit was statistically significant (adjusted OR=6.27). Concerns about influencing children’s smoking behavior had a statistically significant mediation effect on the relationship. After adding the interaction term between noticing the warnings and previous quit attempts, the OR was inflated to 12.92, suggesting a possible interaction. CONCLUSIONS This study offers preliminary insight into how Lebanese smokers are influenced by policy related control measures like health warning labels on cigarette packs. Tobacco control policy advocates should push for stronger enforcement of public smoking bans in general. Behavioral intervention should work on the mediator variables to influence smoking behavior and encourage quitting. Further prospective studies modelling quitting as outcome are needed.
Axillary dissection versus non dissection in negative sentinel node biopsy patients

Background: The goal of this series was to compare performing axillary clearance versus none performing in patients with node biopsy negative.Methods: This study included 114 patients had breast cancer , presented with breast mass no enlarged axillary node either clinically or radiologically and all patients had negative sentinel lymph node intraoperatively those patients presented to Sohag Cancer Center and General Surgery Department Sohag, Egypt during the period of May 2018 to May 2019. Analysis of the clinical presentation, grade of breast cancer and radiological findings was done. All patients with above mentioned criteria were fitted for the study.Results: A total of 114 patients, all of them had sentinel lymph node negative, axillary dissection done in 55 patients of them while 59 patients had no dissection. We divided the patients in our series into group A (with axillary dissection) and group B with non-dissection; in group A 27 (49.1%) patients had lymphoedema on post-operative follow up while in group B none of patients complained from lymphoedema. Numbness was found in 11 (20%) patients among group A patients, while in group B none of patients complained from numbness. On follow up of seroma we discovered that in group A all the patients had seroma while in group B only 9 (15.3%) patients had seroma. None of our 114 patients either with or without dissection had recurrence on follow up period.Conclusions: Clearance of the axilla in sentinel node negative patients has no significant difference in overall survival but also increased rates of lymphoedema, seroma and haematoma.
Downregulation of miR-21 inhibits the malignant phenotype of pancreatic cancer cells by targeting VHL

Background MicroRNA (miR)-21 is overexpressed in numerous types of malignancy and participates in the development of cancer. However, the basic mechanism of the influence of miR-21 on the malignant phenotype of pancreatic cancer remains unclear. Purpose The present study aimed to investigate the role of miR-21 in pancreatic cancer development and explore its molecular mechanism. Patients and methods The tissue samples were collected at the Second Hospital of Tianjin Medical University (Tianjin, China) between January 2013 and December 2015. The expression of VHL in tissue samples was evaluated by IHC staining. The expression of miR-21 was measured by quantitative real-time polymerase chain reaction (qRT-PCR). MiR-21 target gene was detected by real-time PCR, Western blot and the luciferase reporter assay. Cell viability, cell proliferation, cell migration and invasion were evaluated by the MTT assays, the colony formation assays and the transwell assays. The nude mouse tumor xenograft model was performed to detect the effect of miR-21 on tumor growth in vivo. Results Von Hippel-Lindau tumor suppressor (VHL) was downregulated in pancreatic cancer tissues compared with pancreatic non-tumor tissues. VHL was identified as a novel direct target of miR-21, by which it is negatively regulated. In PANC-1 cells, inhibition of miR-21 and upregulation of VHL significantly suppressed cell proliferation, migration and invasion. Knockdown of miR-21 inhibited the hypoxia-inducible factor (HIF)-1α/vascular endothelial growth factor (VEGF) pathway, while inhibiting the expression of matrix metallopeptidase (MMP)-2 and MMP-9. Silencing of miR-21 inhibited tumor growth in vivo. Conclusion Knockdown miR-21 increased the expression of VHL, and thus modulated the HIF-1α/VEGF pathway and the expression of MMP-2 and MMP-9, which led to the inhibition of the proliferation, migration and invasion of pancreatic cancer cells. All of these results suggest that the miR-21/VHL interaction may be a novel potential target for pancreatic cancer prevention and therapy.
Prophylactic antibiotics in patients with episiotomy following normal vaginal delivery: a randomised clinical trial

Background: Postpartum infectious complications following normal vaginal delivery remains a cause of major concern for the health care professionals due to higher morbidity and mortality and prolonged hospital stays and increased healthcare costs which makes us consider prophylactic use of antibiotics after normal vaginal delivery. On the other hand unjudicious use of antibiotics has led to widespread antibiotic resistance. Therefore this study was carried out to validate the use of prophylactic antibiotics in these patients and their role in prevention of puerperial pyrexia, wound infections and prolonged hospital stay.Methods: This Randomised clinical trial was conducted at KCHC-Kerala Co-operative Hospital Complex, Pariyaram, Kannur District, Kerala from 1st March 2012 to 30th April 2013. Eligible women were randomly assigned to group which does not receive prophylactic antibiotics (Group A) and group receiving prophylactic antibiotics (Group B). Patients in both the groups were examined every day till the patient was discharged from the hospital and observed for signs and symptoms of infected episiotomy wound, puerperial pyrexia and duration of hospital stay was noted.Results: Mean age in years was 25.6 for Group A and 26.2 for Group B. Mean gestational age in both the groups was 37.6 weeks. Mean duration of labour was 6.62 and 6.22 hours for Group A and B respectively. 6 subjects in Group A and 5 subjects in Group B had puerperial pyrexia. 3 Subjects in Group A and 2 subjects in Group B had wound infection. The mean duration of hospital stay for Group A was 4.18 with SD of 1.0 while mean hospital stay for Group B was 4.01 with SD of 1.1. Conclusions: By comparing subjects in both the groups with respect to puerperial pyrexia, wound infection and duration of hospital stay there was no statistical difference in any of the above criteria in both groups. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in patients with episiotomy following vaginal delivery as per this study.
Spontaneous Remission of Cancer: Theories from Healers, Physicians, and Cancer Survivors

BACKGROUND: Spontaneous Remission (SR) of cancer is defined as the disappearance, complete or incomplete, of cancer without medical treatment, or with treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor. PURPOSE: This study sought to answer two questions: 1) What causative theories do alternative healers, physicians, and SR survivors propose for SR? ; and, 2) Do SR survivors have a strong Sense of Coherence (SOC)? METHODS: Healers and physicians from 11 countries (n1=50) and SR survivors (n2=20) were interviewed in-depth; 17 of the 20 cancer survivors also completed an SOC scale. RESULTS: Six treatments that may elicit SR emerged frequently among both SR and Healer/Physician subjects: 1) Deepening one's spirituality; 2) Trusting in intuition regarding health decisions; 3) Releasing negative and/or repressed emotions; 4) Feeling love/joy/happiness; 5) Changing one's diet; and, 6) Taking herbal/vitamin supplements. In addition, three underlying theories about health emerged: 1) In order to remit cancer, one must change the underlying conditions that allow it to thrive; 2) Illness=Blockage/Slowness; Health=No Blockage/Movement; and, 3) A body-mind-spirit interaction exists. SOC scale results tentatively indicate that SR subjects may have a higher SOC than general populations, but not than other cancer survivors. IMPLICATIONS: Researchers are encouraged to use the results of this study to design research studies that assess the impact that these six treatments and three theories may have on cancer survival.
Prevalence of Self-reported Polycystic Ovary Syndrome and Profiles of Health Among Women of Different Generations: A Cross Sectional Study

Objective: Although polycystic ovary syndrome (PCOS) is considered a lifelong disorder, very little is understood about the diagnosis and impact of this condition in women outside of the peak reproductive years. We examined the frequency of diagnosed PCOS and concurrent health conditions in women across the lifespan. Methods: Data were analysed from 1509 women aged 15–95 years participating in a cross-sectional, face-to-face population survey in South Australia, 2015. We assessed the prevalence of PCOS in 10-year age groups and the frequency of comorbidities in women with and without PCOS subgrouped by age (< 45, [Formula: see text] 45 years). The main outcome measures were Diagnosed PCOS and other chronic conditions; lifestyle factors. Logistic regression analyses determined the risk of comorbidities in women with PCOS adjusting for age and BMI. Results: Overall prevalence of PCOS was 5.6% (95% confidence interval (CI) 4.6–6.9%), peaking in the 35–44 year age group (9.1%), and lowest in those aged 15–24 (4.1%) or [Formula: see text] 65 (3.7%) years. Women with PCOS and aged <45 years were more likely to report diabetes (16.7% vs. 3.8%), cardiovascular disease (15.5% vs. 7.2%) and arthritis (15.5% vs. 7.2%) than their peers; these differences were diminished in the [Formula: see text] 45 year age group. The odds of diabetes and cardiovascular disease were more than doubled among women with PCOS (adjOR 2.23, 95% CI 1.49–4.31; adjOR 3.18, 95% CI 1.31–7.68). Conclusion: PCOS is underdiagnosed in young and post-menopausal women. Diabetes and cardiovascular disease are key comorbidities requiring greater attention in younger women with PCOS.