Miracle-dz/UniFAR-FTUs huggingface dataset:
Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus.

BACKGROUND It is unclear whether patients with type 2 diabetes who have poor glycaemic control despite maximal oral hypoglycaemic agents (OHAs) should be commenced on insulin as monotherapy, or insulin combined with oral hypoglycaemic agents (insulin-OHA combination therapy). OBJECTIVES To assess the effects of insulin monotherapy versus insulin-OHA combinations therapy. SEARCH STRATEGY Eligible studies were identified by searching MEDLINE, EMBASE, and The Cochrane Library. Date of last search: May 2004. SELECTION CRITERIA Randomised controlled trials (RCTs) with 2 months minimum follow-up duration comparing insulin monotherapy (all schemes) with insulin-OHA combination therapy. DATA COLLECTION AND ANALYSIS Data extraction and assessment of study quality were undertaken by three reviewers in pairs. MAIN RESULTS Twenty RCTs (mean trial duration 10 months) including 1,811 participants, with mean age 59.8 years and mean known duration of diabetes 9.6 years. Overall, study methodological quality was low. Twenty-eight comparisons in 20 RCTs were ordered according to clinical considerations. No studies assessed diabetes-related morbidity, mortality or total mortality. From 13 studies (21 comparisons), sufficient data were extracted to calculate pooled effects on glycaemic control. Insulin-OHA combination therapy had statistically significant benefits on glycaemic control over insulin monotherapy only when the latter was applied as a once-daily injection of NPH insulin. Conversely, twice-daily insulin monotherapy (NPH or mixed insulin) provided superior glycaemic control to insulin-OHA combination therapy regimens where insulin was administered as a single morning injection. In more conventional comparisons, regimens utilising OHAs with bedtime NPH insulin provided comparable glycaemic control to insulin monotherapy (administered as twice daily, or multiple daily injections). Overall, insulin-OHA combination therapy was associated with a 43% relative reduction in total daily insulin requirement compared to insulin monotherapy. Of the 14 studies (22 comparisons) reporting hypoglycaemia, 13 demonstrated no significant difference in the frequency of symptomatic or biochemical hypoglycaemia between insulin and combination therapy regimens. No significant differences in quality of life related issues were detected. Combination therapy with bedtime NPH insulin resulted in statistically significantly less weight gain compared to insulin monotherapy, provided metformin was used +/-sulphonylurea. In all other comparisons no significant differences with respect to weight gain were detected. REVIEWERS' CONCLUSIONS Bedtime NPH insulin combined with oral hypoglycaemic agents provides comparable glycaemic control to insulin monotherapy and is associated with less weight gain if metformin is used.
Paleoparasitologia no Brasil

We review the beggining of paleoparasitology and its development in Brazil. The search of parasites in ancient human remains can throw light on such questions as origin and antiquity of parasite-host relationship, general distribution of parasites through time and prehistoric human migrations. The study of parasite DNA sequences found in mummified tissues and coprolites can be an important source of information for phylogenetic and host-parasite coevolution. The nucleic acid based techniques (molecular paleoparasitology) open a new perspective to evolution at a molecular level.
A comparative study of three Spanish eGoverment smart cards

Smart cards are well-known tamper-resistant devices, and due to their portability and security they represent an excellent platform for implementing strong authentication services. This contribution analyses three Spanish smart card deployments intended to be used for eGoverment services, comparing their respective contents and capabilities. As a result of our analysis, we conclude that the current deployment of smart cards for the electronic prescription service being rolled out throughout Spain could be replaced by the use of the already consolidated Spanish National Identity card.
Accelerated Integrated Science Sequence (AISS): An Introductory Biology, Chemistry, and Physics Course for College Students

A new interdisciplinary, introductory science course was offered for the first time during the 2007–2008 school year. The purpose of the course is to introduce students to the idea of working at the intersections of biology, chemistry, and physics and to recognize interconnections between the disciplines. Interdisciplinary laboratories are a key point of connection between the various disciplines. The philosophy behind the design of the course, details about the course structure, and examples of interdisciplinary laboratories that involved the chemical concepts in the course are provided.
Weak isolation by distance in Diaperis boleti, a fungivorous saproxylic beetle.

Living in unstable habitats is expected to decrease the intensity of isolation by distance in populations through the need for frequent movements of individuals. Insects associated with fruiting bodies of fungi therefore are supposed to have weak spatial genetic structure of populations compared with those living in more stable habitats. With the use of an amplified fragment length polymorphism technique, this study investigated the isolation by distance, inbreeding, and genetic diversity in Diaperis boleti (L.) (Coleoptera: Tenebrionidae), a fungivorous saproxylic beetle that inhabits sporocarps of Laetiporus sulphureus (Bulliard) Murrill (Polyporales) on trees growing in highly-fragmented agricultural landscapes. Isolation by distance was tested with spatial autocorrelation analysis of kinship (individual-based approach) and correlating matrices of genetic and geographic distances with the Mantel test (population-based approach). These results were compared with the results obtained for saproxylic beetles living in the same landscape but differing in ecological preferences. It was shown that the species dependent on sporocarps of wood-decomposing fungi had higher variability, lower individual inbreeding, and less intensive isolation by distance pattern than saproxylic beetles living in tree hollows. It was also demonstrated that spatial autocorrelation analysis of kinship is a more sensitive approach for detecting fine-scale spatial genetic structure than the Mantel test.
Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management

Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are classified traditionally into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey zone between benign and malignant, as their behaviour cannot be predicted reliably. Defined pathological categorization of such lesions is challenging, and for some entities is recognized to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over‐ or undertreatment. The rarity of these lesions makes the acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision‐making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification and behaviour, and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential, such as low‐grade adenosquamous carcinoma, low‐grade fibromatosis‐like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions of uncertain malignant nature remain, such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of (1) breast lesions of uncertain malignant nature and (2) breast lesions of limited metastatic potential are proposed with details of which histological entities could be included in each category, and their management implications are discussed.
Pharmacological interventions for hypertensive emergencies.

BACKGROUND Hypertensive emergencies, marked hypertension associated with acute end-organ damage, are life-threatening conditions. Many anti-hypertensive drugs have been used in these clinical settings. The benefits and harms of such treatment and the best first-line treatment are not known. OBJECTIVES To answer the following two questions using randomized controlled trials (RCTs): 1) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency? 2) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients? SEARCH STRATEGY Electronic sources: MEDLINE, EMBASE, Cochrane clinical trial register. In addition, we searched for references in review articles and trials. We attempted to contact trialists. Most recent search August 2007. SELECTION CRITERIA All unconfounded, truly randomized trials that compare an antihypertensive drug versus placebo, no treatment, or another antihypertensive drug from a different class in patients presenting with a hypertensive emergency. DATA COLLECTION AND ANALYSIS Quality of concealment allocation was scored. Data on randomized patients, total serious adverse events, all-cause mortality, non-fatal cardiovascular events, withdrawals due to adverse events, length of follow-up, blood pressure and heart rate were extracted independently and cross checked. MAIN RESULTS Fifteen randomized controlled trials (representing 869 patients) met the inclusion criteria. Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (9 trials), ACE-inhibitors (7), diuretics (3), calcium channel blockers (6), alpha-1 adrenergic antagonists (4), direct vasodilators (2) and dopamine agonists (1). Mortality event data were reported in 7 trials. No meta-analysis was performed for clinical outcomes, due to insufficient data. The pooled effect of 3 different anti-hypertensive drugs in one placebo-controlled trial showed a statistically significant greater reduction in both systolic [WMD -13, 95%CI -19,-7] and diastolic [WMD -8, 95%CI, -12,-3] blood pressure with antihypertensive therapy. AUTHORS' CONCLUSIONS There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer term mortality and morbidity outcomes.
Chemoradiotherapy followed by surgery in rectal cancer: improved local control using a moderately high pelvic radiation dose.

BACKGROUND To determine complete resection and sphincter preservation rates, down-staging, local control and survival associated with concurrent chemoradiotherapy (CCRT) using a moderately high pelvic radiation dose before surgery in rectal cancer. METHODS Fifty-seven patients with histologically proven adenocarcinoma of the mid to lower rectum were treated using preoperative CCRT and surgery. Median radiation dose to the pelvis was 5400 cGy (5040-5580 cGy). CCRT was administered during the first and fifth weeks of radiotherapy with bolus intravenous 5-fluorouracil (5-FU) 400 mg/m(2)/day and leucovorin (LV) 20 mg/m(2)/day for 5 days. Surgery was attempted 4-8 weeks after completing preoperative CCRT. Post-operative chemotherapy was then added for up to four cycles of intravenous 5-FU and LV. RESULTS Toxicities during CCRT were generally mild and manageable: Grade 1/2 anemia, 3.5%; Grade 1/2 leukopenia, 45.6%; Grade 3 leukopenia, 3.5%; Grade 1/2 diarrhea, 22.8%; Grade 1/2 abdominal discomfort, 7%; and perianal skin reaction, 5.3%. No late complication requiring surgical intervention occurred. Complete surgical resection with a negative resection margin was achieved in 98.2% of patients, and the down-staging rate was 52.6% (30/57; 95% CI 39.6-65.6%). Complete pathologic response was obtained in 5.3% patients (3/57; 95% CI 0-11.1%) and in other 2 patients only sporadic tumor cells nests were noted in surgical specimens. The sphincter preservation rate was 77.2% (44/57; 95% CI 66.3-88.1%). Of 30 patients with tumors located within 5 cm from the anal verge, sphincter preservation was possible in 18 patients (60.0%; 95% CI 47.3-72.7%). With a median follow-up duration of 40 months, overall and disease-free survival (DFS) rates over 3 years were 91.8% (95% CI 85.5-98.2%) and 79.7% (95% CI 71.2-88.2%), respectively. At univariate analysis, significant factors for DFS was LN involvement status (P = 0.024). Local and distant failure rates over the same period were 5.3 and 21.1%, respectively. CONCLUSIONS Preoperative CCRT produced encouraging down-staging rates and was found to facilitate complete resection and sphincter saving in distal rectal cancer with acceptable toxicity. Further studies are warranted using this moderately high radiation dose to the pelvis to improve the local control.
Long-term observation of 64 patients with roentgenographically occult lung cancer treated with external irradiation and intraluminal irradiation using low-dose-rate iridium.

OBJECTIVE Therapeutic results of intraluminal irradiation were analyzed in 64 patients with roentgenographically occult lung cancer (ROLC). METHODS The subjects were 64 patients who underwent intraluminal irradiation between 1987 and 2003. Radiotherapy was performed by combining external irradiation with intraluminal irradiation using low-dose-rate iridium (four 370-MBq wires) through a catheter with a spacer. The doses of radiation were 0-70 Gy (median value 46 Gy) by external irradiation and 10-60 Gy (median value 29.3 Gy) by intraluminal irradiation. RESULTS The therapeutic effect was CR in 63 patients and PR in 1 patient, and local recurrence was observed in a PR case and in seven of the 63 patients who showed CR. The 5-year overall and relapse-free survival rates were 56 (95% CI, 43-69%) and 55% (95% CI, 43-68%), respectively. Fatal pulmonary hemorrhage was observed in one case. CONCLUSIONS Considering the facts that ROLC often occurs as multiple cancers and that many patients with ROLC have reduced lung function, radiation therapy by a combination of intraluminal and external irradiation may replace surgery as the first choice for the treatment of this disease.
Chitosan for overweight or obesity.

BACKGROUND Chitosan, a deacetylated chitin, is a dietary supplement reported to decrease body weight. It is widely available over the counter worldwide and although evaluated in a number of trials its efficacy remains in dispute. OBJECTIVES To assess the effects of chitosan as a treatment for overweight and obesity. SEARCH STRATEGY We searched electronic databases (MEDLINE, EMBASE, BIOSIS, CINAHL, The Cochrane Library), specialised web sites (Controlled Trials, IBIDS, SIGLE, Reuter's Health Service, Natural Alternatives International, Pharmanutrients), bibliographies of relevant journal articles, and contacted relevant authors and manufacturers. SELECTION CRITERIA Trials were included in the review if they were randomised controlled trials of chitosan for a minimum of four weeks duration in adults who were overweight or obese. Authors of included studies were contacted for additional information where appropriate. DATA COLLECTION AND ANALYSIS Details from eligible trials were extracted independently by two reviewers using a standardised data extraction form. Differences in data extraction were resolved by consensus. Continuous data were expressed as weighted mean differences and standard deviations. The pooled effect size was computed by using the inverse variance weighted method. MAIN RESULTS Fifteen trials including a total of 1219 participants met the inclusion criteria. No trial to date has measured the effect of chitosan on mortality or morbidity. Analyses indicated that chitosan preparations result in a significantly greater weight loss (weighted mean difference -1.7 kg; 95% confidence interval (CI) -2.1 to -1.3 kg, P < 0.00001), decrease in total cholesterol (-0.2 mmol/L [95% CI -0.3 to -0.1], P < 0.00001), and a decrease in systolic and diastolic blood pressure compared with placebo. There were no clear differences between intervention and control groups in terms of frequency of adverse events or in faecal fat excretion. However, the quality of many studies was sub-optimal and analyses restricted to studies that met allocation concealment criteria, were larger, or of longer duration showed that such trials produced substantially smaller decreases in weight and total cholesterol. AUTHORS' CONCLUSIONS There is some evidence that chitosan is more effective than placebo in the short-term treatment of overweight and obesity. However, many trials to date have been of poor quality and results have been variable. Results obtained from high quality trials indicate that the effect of chitosan on body weight is minimal and unlikely to be of clinical significance.
In reply to Hynes et al.: ‘Back to the future: routine morphological assessment of the tumour microenvironment is prognostic in stages II/III colon cancer in a large population‐based study’

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Quality and Outcome Indicators for Prevention of Type 2 Diabetes In Europe −; IMAGE

14| 2010 The IMAGE project was launched to unify and improve the various diabetes prevention management concepts which currently exist within the European Union. As part of the IMAGE project, a set of quality and scientific outcome evaluation indicators for diabetes prevention programmes were developed. This report describes the background and the methods used in the development of the quality tools in the IMAGE project. It presents the European quality indicators for diabetes primary prevention programmes and is targeted at persons responsible for diabetes prevention at different levels within the health care system. The quality indicators are presented separately for population-level, screening for high risk and high-risk prevention strategies. The indicators are further divided quality and scientific outcome evaluation indicators. References to measurement standards for scientific outcome evaluation indicators are provided. In addition to the indicators, the report includes audit and data collection forms. These quality tools complement the IMAGE Evidence-Based Guideline and IMAGE Toolkit and will hopefully provide a tool for improving the quality of diabetes prevention in Europe.
Acupuncture for depression.

BACKGROUND There is interest from the community in the use of self help and complementary therapies for depression. This review examined the currently available evidence supporting the use of acupuncture to treat depression. OBJECTIVES To examine the effectiveness and adverse effects of acupuncture in the treatment for depression. SEARCH STRATEGY The following databases were searched: CCDAN-CTR, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to Dec 2008), EMBASE (1980 to Dec 2008), PSYCINFO (1874 to Dec 2008), the Database of Abstracts of Reviews of Effectiveness (DARE), CINAHL (1980 to Dec 2008), Wan Fang database (to Dec 2008). The following terms were used: depression, depressive disorder, dysthymic disorder and acupuncture. SELECTION CRITERIA Inclusion criteria included all published and unpublished randomised controlled trials comparing acupuncture with sham acupuncture, no treatment, pharmacological treatment, other structured psychotherapies (cognitive behavioural therapy, psychotherapy or counselling), or standard care. The following modes of treatment were included: acupuncture, electro acupuncture or laser acupuncture. The participants included adult men and women with depression defined by clinical state description, or diagnosed by the Diagnostic and Statistical Manual (DSM-IV), Research Diagnostic Criteria (RDC), International Classification of Disease (ICD) or the Criteria for Classification and Diagnosis of Mental Diseases CCMD-3-R. DATA COLLECTION AND ANALYSIS Meta-analyses were performed using relative risk for dichotomous outcomes and standard mean differences for continuous outcomes, with 95% confidence intervals. Primary outcomes were reduction in the severity of depression, measured by self rating scales, or by clinician rated scales and an improvement in depression defined as remission versus no remission. MAIN RESULTS This review is an update and now contains data from 30 studies. Following recent searches, 23 new studies have been added and a further 11 trials were excluded (due to suboptimal doses of medication, no clinical outcomes, insufficient reporting). Thirty trials with 2,812 participants are included in the meta-analysis.There was a high risk of bias in the majority of trials. There was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control. Two trials found acupuncture may have an additive benefit when combined with medication compared with medication alone. A subgroup of participants with depression as a co-morbidity experienced a reduction in depression with manual acupuncture compared with SSRIs (RR 1.66, 95%CI 1.03, 2.68) (three trials, 94 participants). The majority of trials compared manual and electro acupuncture with medication and found no effect between groups. AUTHORS' CONCLUSIONS We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.