Miracle-dz/UniFAR-FTUs huggingface dataset:
Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes.

OBJECTIVE The purpose of this article is to report our intermediate to long-term outcomes with image-guided percutaneous hepatic tumor cryoablation and to evaluate its technical success, technique efficacy, local tumor progression, and adverse event rate. MATERIALS AND METHODS Between 1998 and 2014, 299 hepatic tumors (243 metastases and 56 primary tumors; mean diameter, 2.5 cm; median diameter, 2.2 cm; range, 0.3-7.8 cm) in 186 patients (95 women; mean age, 60.9 years; range, 29-88 years) underwent cryoablation during 236 procedures using CT (n = 126), MRI (n = 100), or PET/CT (n = 10) guidance. Technical success, technique efficacy at 3 months, local tumor progression (mean follow-up, 2.5 years; range, 2 months to 14.6 years), and adverse event rates were calculated. RESULTS The technical success rate was 94.6% (279/295). The technique efficacy rate was 89.5% (231/258) and was greater for tumors smaller than 4 cm (93.4%; 213/228) than for larger tumors (60.0%; 18/30) (p < 0.0001). Local tumor progression occurred in 23.3% (60/258) of tumors and was significantly more common after the treatment of tumors 4 cm or larger (63.3%; 19/30) compared with smaller tumors (18.0%; 41/228) (p < 0.0001). Adverse events followed 33.8% (80/236) of procedures and were grade 3-5 in 10.6% (25/236) of cases. Grade 3 or greater adverse events more commonly followed the treatment of larger tumors (19.5%; 8/41) compared with smaller tumors (8.7%; 17/195) (p = 0.04). CONCLUSION Image-guided percutaneous cryoablation of hepatic tumors is efficacious; however, tumors smaller than 4 cm are more likely to be treated successfully and without an adverse event.
Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis

Abstract Background & Aims: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain. Methods: Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs. Results: Twenty patients treated with TIPS and 18 treated with paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 ± 43 vs. 325 ± 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the paracentesis group ( P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the paracentesis group. Conclusions: In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated paracentesis plus albumin. GASTROENTEROLOGY 2002;123:1839-1847
Diagnostic Performance of Monoexponential DWI Versus Diffusion Kurtosis Imaging in Prostate Cancer: A Systematic Review and Meta-Analysis.

OBJECTIVE We aimed to compare the diagnostic performance of monoexponential DWI and diffusion kurtosis imaging (DKI) for the detection of prostate cancer (PCa). MATERIALS AND METHODS A systematic literature search was conducted for studies evaluating the diagnostic value of monoexponential DWI and DKI for PCa in the same patient cohorts with sufficient data to construct 2 × 2 contingency tables. Qualities of the included studies were assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data were extracted to calculate pooled sensitivities and specificities. We constructed summary ROC curves and calculated AUCs to determine the performances of DKI parameters (diffusion coefficient and kurtosis characterizing the deviation from the monoexponential decay) and apparent diffusion coefficient (ADC) values in diagnosing PCa. RESULTS Five studies (463 patients) were included, with eight, nine, and 10 subsets of data available for analysis of ADC, diffusion, and kurtosis, respectively. Pooled sensitivities were 89% (95% CI, 80-94%) for ADC, 91% (95% CI, 84-95%) for diffusion, and 87% (95% CI, 83-91%) for kurtosis. Pooled specificities were 86% (95% CI, 80-90%) for ADC, 78% (95% CI, 71-84%) for diffusion, and 85% (95% CI, 81-89%) for kurtosis. According to the summary ROC analyses, the AUC was 0.93 (95% CI, 0.90-0.95) for ADC, 0.89 (95% CI, 0.86-0.92) for diffusion, and 0.93 (95% CI, 0.90-0.95) for kurtosis. There was no notable publication bias, but significant heterogeneity was observed. CONCLUSION Monoexponential DWI and DKI showed comparable diagnostic accuracies for PCa. DKI is a potentially helpful method for the diagnosis of PCa. Therefore, on the basis of current evidence, we do not recommend including DKI in routine clinical assessment of PCa for the moment.
Impact of post myocardial infarction depression on drug adherence of cardiological medicines

Background: Depressive symptoms are very usual in patients experiencing a history of myocardial infarction (MI). An individual who has developed depression after an episode of MI becomes non compliant with the treatment of cardiology. Aim: To test the impact of post MI depression on drug adherence of cardiological medicines. Settings and design: The study was conducted on patients of acute MI (n=50) attending cardiology outpatient department (OPD) of Assam Medical College and Hospital, Dibrugarh at eight weeks after the index event. Methods: Screening was performed by the Primary Care Evaluation of Mental Disorders (PRIMEMD) and diagnoses of major depressive disorder were established according to the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria. The eight-item Morisky Medication Adherence Questionnaire was applied to the patients to assess drug adherence after eight weeks from the MI episode. Results: Statistically significant strong association and correlation were found between post MI depression and drug adherence of cardiological medicines (Wald 9.84, Odd’s ratio 2.054, p=0.002, rho=0.714). Conclusion: The result of analysis has revealed that post MI depression has an unfavourable impact on drug adherence, ultimately contributing to increased risk of cardiological morbidity and death rate. Therefore, routine screening of depressive symptoms should be mandatory in cardiology. Dutta H, Ghosh S, Dutta DJ. Impact of post myocardial infarction depression on drug adherence of cardiological medicines. Open J Psychiatry Allied Sci. 2015;6:106-11.doi: 10.5958/2394-2061.2015. 00006.3
The impact of interlaboratory differences in cystatin C assay measurement on glomerular filtration rate estimation.

BACKGROUND AND OBJECTIVES Cystatin C (CysC) is a promising marker of GFR. Several equations have been derived to estimate GFR from its serum concentration. Heterogeneity in the performance of these equations exists in validation studies even when the same CysC assay from the same manufacturer is utilized. This study was designed to examine the differences in CysC and GFR estimation (eGFR) using Siemens' nephelometric immunoassay and the Mayo Clinic equation. The ability of the eGFRs to predict measured GFR was also examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Ninety-seven split samples were sent to laboratories at Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada, and at the Mayo Clinic in Rochester, Minnesota. RESULTS The mean CHEO CysC was 0.17 mg/L (10%) lower than the mean Mayo Clinic CysC. Using the Mayo Clinic equation, the mean eGFR difference was 7.2 ml/min per 1.73 m(2) (15%). Approximately 36% of the results agreed within 10%, while 13% were discordant by greater than 30%. Larger absolute differences in mean eGFR between the two laboratories were found in the subgroup with CysC less than 1.41 mg/L as compared with the subgroup greater than 1.41 mg/L (9.5 versus 5.0 ml/min per 1.73 m(2)). Correction of CHEO values to the Mayo Clinic did not improve GFR estimation. CONCLUSIONS Significant differences in CysC measurement exist between laboratories using the same assay by the same manufacturer and these lead to clinically relevant differences in GFR estimation. This interlaboratory variability needs to be recognized when interpreting and comparing CysC and eGFR results.
Albuminuria and estimated glomerular filtration rate as predictors of diabetic end-stage renal disease and death.

BACKGROUND AND OBJECTIVES We investigated predictive value of albuminuria and estimated GFR (eGFR) for ESRD in Pima Indians with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Beginning in 1982, 2420 diabetic Pima Indians ≥18 years old were followed until they developed ESRD or died or until December 31, 2005. Individuals were classified at baseline by urinary albumin-to-creatinine ratio (ACR) and by eGFR, calculated by the Chronic Kidney Disease Epidemiology Collaboration equation. Predictors of ESRD and mortality were examined by proportional hazards regression. RESULTS During a mean follow-up of 10.2 years, 287 individuals developed ESRD. Incidence of ESRD among individuals with macroalbuminuria (ACR ≥ 300 mg/g) was 9.3 times that of those with normoalbuminuria (ACR < 30 mg/g), controlled for age, gender, and duration of diabetes. Incidence among individuals with eGFR 15 to 29 ml/min per 1.73 m(2) was 81.9 times that of those with eGFR 90 to 119 ml/min per 1.73 m(2). Models that combined albuminuria and eGFR added significant predictive information about risk of ESRD or death compared with models containing eGFR or albuminuria alone. The hazard ratio for ESRD associated with a 10-ml/min per 1.73 m(2) lower eGFR was 1.36, whereas that associated with an increase in albuminuria category was 2.69; corresponding hazard ratios for death were 1.15 and 1.37. CONCLUSIONS These results suggest that incorporation of quantitative information about albuminuria into staging systems based on eGFR adds significant prognostic information about risk for diabetic ESRD and death.
An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry).

BACKGROUND AND OBJECTIVES Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. RESULTS The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality. CONCLUSIONS Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.
Impact of Length Difference in Risk and Comparison Windows: A Cautionary Note

Postmarketing observational safety studies seek to identify potential rare events that may be associated with a licensed product but could not be detected in clinical studies. In vaccine postmarketing safety studies, it is often useful to compare incidence rate in a risk period immediately following vaccination versus a longer self-comparison period for many (usually several hundreds or even thousands) medical events. It is recognized that when the risk and comparison event rates are the same, some of the tests for a difference between the two periods will reach significance by chance alone, and in this case, one would expect the differences reaching significance to be equally likely to be favorable or unfavorable. However, when the risk and comparison periods differ in length and events are rare, all or most of the significant findings could favor the group with longer follow-up even after accounting for the differential length of follow-up. An investigation of this phenomenon confirms that unequal comparison periods can affect the direction of chance findings and shows that the magnitude depends on the expected number of events in the risk period.
Psychometric Properties of the Cannabis Use Disorders Identification Test in French Cannabis Misusers

&NA; This study evaluates the French version of the Cannabis Use Disorders Identification Test (CUDIT) in a clinical sample with a high rate of cannabis misuse. A group of 194 cannabis users, including 134 outpatients (Group 1) seen at a specific cannabis clinic and 60 drug/alcohol addicts hospitalized for withdrawal (Group 2), filled out the CUDIT. The majority (82% of the sample) were cannabis dependent or abusers (DSM‐IV). Internal reliability was assessed by Cronbach's alpha, item‐total correlation by Spearman's rho and temporal reliability by the test‐retest method. Construct validity was evaluated by factor analysis. Convergent validity was evaluated by measuring the correlation with the quantity of cannabis consumed. The cut‐off score used to distinguish cannabis users from misusers was set using a Receiver Operating Characteristic curve analysis. Cronbach's alpha was high (0.83). There was no significant difference between the total test and retest scores (p = 0.1) indicating good temporal reliability. Principal component analysis identified 2 principle factors that explained 53.1% of the total variance. Convergent validity was significant and satisfactory. The cut‐off value was 10, which corresponded to the optimal sensitivity (94.4%) and positive predictive value (90.4%). However, the item‐total correlation and the correlation with abuse and dependence severity were mediocre for item 9. It should be removed because of its poor psychometric properties. The CUDIT is a satisfactory screening instrument for cannabis use disorders in at‐risk populations.
The impact on parenting and the home environment of early support to mothers with new babies

The study reported here aimed to evaluate the impact on parenting and the home environment of community volunteer home visiting offered during or soon after pregnancy to potentially vulnerable mothers. A cluster‐randomised study allocated Home‐Start schemes to intervention or comparison (existing services) conditions. Mothers were screened at routine health checks. Families in intervention and comparison areas were assessed at two and 12 months. The results showed that comparing families receiving support and those in comparison areas, there were few differences. There was a greater reduction in parent‐child relationship difficulties for supported families, but they offered their children fewer healthy foods. There was no evidence of enhanced parenting, organisation of the home environment or more appropriate use of health services. Comparing families receiving support with a second comparison group, living in intervention areas but not receiving support, no differences were found. The article concludes that a more structured approach may be required to make changes in parenting behaviour and the home environment.
Associations of triiodothyronine levels with carotid atherosclerosis and arterial stiffness in hemodialysis patients.

BACKGROUND AND OBJECTIVES End-stage renal disease is linked to alterations in thyroid hormone levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low triiodothyronine (T3) levels. These alterations are involved in endothelial damage, cardiac abnormalities, and inflammation, but the exact mechanisms are unclear. In this study, we investigated the relationship between serum free-T3 (fT3) and carotid artery atherosclerosis, arterial stiffness, and vascular calcification in prevalent patients on conventional hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS 137 patients were included. Thyroid-hormone levels were determined by chemiluminescent immunoassay, carotid artery-intima media thickness (CA-IMT) by Doppler ultrasonography, carotid-femoral pulse wave velocity (c-f PWV), and augmentation index by Sphygmocor device, and coronary artery calcification (CAC) scores by multi-slice computerized tomography. RESULTS Mean fT3 level was 3.70 ± 1.23 pmol/L. Across decreasing fT3 tertiles, c-f PWV and CA-IMT values were incrementally higher, whereas CACs were not different. In adjusted ordinal logistic regression analysis, fT3 level (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97), age, and interdialytic weight gain were significantly associated with CA-IMT. fT3 level was associated with c-f PWV in nondiabetics but not in diabetics. In nondiabetics (n = 113), c-f PWV was positively associated with age and systolic BP but negatively with fT3 levels (odds ratio = 0.57, 95% confidence interval 0.39 to 0.83). CONCLUSIONS fT3 levels are inversely associated with carotid atherosclerosis but not with CAC in hemodialysis patients. Also, fT3 levels are inversely associated with surrogates of arterial stiffness in nondiabetics.
Multidisciplinary Allocation of Pain Treatment: Long-Term Outcome and Correlates of Cognitive-Behavioral Processes

Objective: To investigate the long-term effects of multidisciplinary allocation of pain treatment on pain intensity, functional disability, depression, and medication use in outpatients with chronic pain, and to identify cognitive-behavioral predictors [worrying, avoidance behavior, fear of pain, helplessness, and acceptance] of the primary outcome measures. Methods: Eighty-six outpatients with chronic pain who were treated at a multidisciplinary pain center completed various questionnaires and a pain diary one week before treatment started, and 3 and 12 months later. Results: Functional disability and depression improved significantly 12 months after the start of treatment in comparison with before treatment. The decrease in scores for the cognitive-behavioral variables worrying, fear of pain, helplessness, and avoidance behavior at three months was associated with the decrease in functional disability and depression at 12 months. Conclusion: Patients with chronic pain may benefit in the long term from multidisciplinary allocation to pain treatment with respect to functional disability and depression. Changes of cognitive-behavioral processes seem to contribute to achieving long-term effects of multidisciplinary allocation of pain treatment. There is a need for high quality clinical trials in this field in order to clarify the specific contribution of cognitive-behavioral process variables.
Determination and validation of aortic calcification measurement from lateral bone densitometry in dialysis patients.

BACKGROUND AND OBJECTIVES Vascular calcification (VC) contributes to increased cardiovascular (CV) disease in dialysis patients and is inversely correlated with bone mineral density (BMD). Screening for VC may determine patients at greater CV risk and bone densitometry may have dual role in assessing VC as well as BMD. The aim of this study was to determine measurement of VC using dual-energy x-ray absorptiometry (DXA) with correlation to gold standard computed tomography (CT). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Forty hemodialysis patients had abdominal aortic CT and lateral DXA of lumbar spine to determine aortic VC and BMD. Semiquantitative measurement of aortic VC from lateral DXA was determined using previously validated 24- and 8-point scales and correlated with aortic VC with CT. Anteroposterior (AP) and lateral DXA-reported BMD was compared with BMD from L2 through L4 with CT. RESULTS Patients, 70% men, 38% diabetic, had median age 58.5 yr. Aortic VC was present in 94% with CT and 68% on lateral DXA. For 24- and 8-point scores, intraclass correlation coefficients for intrarater agreement were 0.93 and 0.88, respectively. DXA-measured VC correlated with CT. Sensitivity and specificity for CT aortic VC > or = 500 HU was 50 and 86%, respectively, for DXA VC > or = 6 on a 24-point scale. Lateral DXA-reported BMD significantly correlated with BMD from CT, but AP DXA did not. CONCLUSIONS Lateral DXA may be useful because images may provide concurrent assessment of aortic calcification as well as more accurate lumbar spine BMD, avoiding some of the limitations of AP DXA.
Standing on One’s Own Feet: New Graduate Nurses’ Home Health Care Challenges and Work Experiences Study

Interest is growing for information on recently qualified nurses’ initial meeting with working life. This study aims to shed light on recently qualified nurses’ experience working in home health care. The authors chose to design the study using a phenomenological hermeneutical approach with narrative interviews and text analysis. The respondents consist of a group of four recently qualified nurses. The results show that they are surprised by the many competence requirements and expectations, that they experience feeling alone, and that they also bear large responsibility. At the same time, they enjoy their work, in which they seek to influence the working conditions for their professional practice. They do experience the anxiety of not being able to cope with the challenge of nursing practice, but they are not marked by the shock of reality.