Miracle-dz/UniFAR-FTUs huggingface dataset:
Academic Centers Are Associated with Improved Survival Outcomes in High Risk Diffuse Large B-Cell Lymphoma Patients

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and is characterized as a heterogenous disease associated with varying outcomes. The International Prognostic Index (IPI) has been the standard for baseline prognostic assessment in these patients. In this study we aimed to determine the impact of treatment facility (academic versus non-academic centers) on overall survival outcomes in DLBCL patients stratified by IPI score risk groups, with a focus on high risk disease as this is associated with poorer outcomes. Methods: The 2018 National Cancer Database (NCDB) was utilized for patients diagnosed with DLBCL between 2004-2015. Patients were then stratified based on IPI risk score from low to high risk. Four risk groups were formed: low (0-1), low-intermediate (2), high-intermediate (3), and high (4-5). Overall survival was calculated using Kaplan-Meyer analysis with bivariate cox proportional hazard ratios to compare survival by facility type (academic or community centers) within these risk groups. Results: A total of 160,137 patients were identified. Of these cases 31.8% were classified as low risk, 21.9% were low-intermediate risk, 22.2% were high-intermediate risk, and 24% were high risk. 59.3% of patients were treated at a community center and 40.7% were treated at academic centers. Treatment at academic centers was associated with a significantly improved overall survival (OS) for each risk category. Median survival (in months) for high risk IPI score DLBCL was 47.9 months in community and 61.1 months in academic centers (p<.0001). Median survival for high-intermediate risk score was 48.3 months in community and 87.3 months in academic centers (p<.0001). Median survival for low-intermediate score was 90.3 months in community and 122.8 months in academic centers (p<.0001). Median survival for low risk score was 132 months in community and 148 months in academic centers (p<.0001). Hazard ratios for academic center versus community center for high risk, high-intermediate, low-intermediate and low risk are 0.768, 0.71, 0.848 and 0.818 respectively (p<.0001). Conclusions: Facility type is significantly associated with improved survival outcomes across all IPI based risk groups for DLBCL. This benefit is especially significant in higher risk disease where positive outcomes are less common, suggesting treatment at academic centers may be particularly beneficial in these patients. Some of the possible reasons for this difference may include provider experience, increased access to resources, and opportunity for clinical trials. Further investigations into the factors contributing to such disparities should be done to help standardize care and improve outcomes. No relevant conflicts of interest to declare.
Could methylated reprimo cell-free DNA serve as a novel tumor marker to assess response in locally advanced gastric cancer treated with preoperative chemotherapy?

101 Background: Gastric cancer (GC) is one of the leading causes of cancer death. Perioperative chemotherapy (CT) for locally advanced GC improves curative resection rates and survival compared to surgery alone. Response assessment is challenging and no tumor markers have been validated for this purpose. We conducted a pilot study to investigate the role of methylated Reprimo (RPRM) cell-free DNA (cfDNA) as tumor marker for assessment of response to preoperative CT in patients enrolled in the study GOCCHI 2009-01 (NCT01633203). Methods: Patients with locally advanced GC referred to receive preoperative CT with Epirubicin + Cisplatin + Capecitabine for 3 cycles were offered to enter the study. Patients had to have operable GC, with baseline CT showing a transmural tumor and/or regional lymphnode metastasis with no distant spread assessed by a multidisciplinary tumor board. After the approval of the amendment of the protocol to allow blood sampling for tumor marker measurement and only if informed consent h.
Scientific evidence-based prescribing in primary health care

Introduction: evidence-based medicine is a natural response to the need of creating a healthcare model that allows the integration of the results of the advances in clinical research into daily practice. Objectives: To characterize the use of evidence-based medicine in the act of prescribing. Methods: We conducted a cross sectional study in the first level of care. We included, at random, 9 provinces (Santiago de Cuba, Havana, Matanzas, Pinar del Rio, Camagüey, Ciego de Avila, Holguín, Granma and Guantanamo) that constitute 60 % and of these, 25 % of the clinics (82). The selection of these was by simple random sampling with the statistical program EPIDAT. 765 prescribers were included since they were serving in the selected areas at the time of the application of this instrument. For the collection of information a questionnaire "Prescribing scientific evidence" was designed in order to capture all the information on the variables defined. Results: Over half of respondents (442) noted that often feel the need to seek information, this necessity increases when less time professional experience, although the frequency of seeking for more information is annually low, with an average of 6, 48 times a year and a mode of zero. Concerning prescriptions, the respondents reported having more questions (69.4 %) about drug interactions. Conclusions: Half of the respondents stated that they often feel a need for review of scientific literature to answer questions during the act of prescribing. However, the sources they use are printed and updating courses. Interactions and adverse reactions are the aspects that they usually seek about, but they refer they often take into account the availability of the drug at the time of prescribing.
Developing Embodied Conversational Agents for Coaching People in a Healthy Lifestyle: Scoping Review

Background Embodied conversational agents (ECAs) are animated computer characters that simulate face-to-face counseling. Owing to their capacity to establish and maintain an empathic relationship, they are deemed to be a promising tool for starting and maintaining a healthy lifestyle. Objective This review aimed to identify the current practices in designing and evaluating ECAs for coaching people in a healthy lifestyle and provide an overview of their efficacy (on behavioral, knowledge, and motivational parameters) and use (on usability, usage, and user satisfaction parameters). Methods We used the Arksey and O’Malley framework to conduct a scoping review. PsycINFO, Medical Literature Analysis and Retrieval System Online, and Scopus were searched with a combination of terms related to ECA and lifestyle. Initially, 1789 unique studies were identified; 20 studies were included. Results Most often, ECAs targeted physical activity (n=16) and had the appearance of a middle-aged African American woman (n=13). Multiple behavior change techniques (median=3) and theories or principles (median=3) were applied, but their interpretation and application were usually not reported. ECAs seemed to be designed for the end user rather than with the end user. Stakeholders were usually not involved. A total of 7 out of 15 studies reported better efficacy outcomes for the intervention group, and 5 out of 8 studies reported better use-related outcomes, as compared with the control group. Conclusions ECAs are a promising tool for persuasive communication in the health domain. This review provided valuable insights into the current developmental processes, and it recommends the use of human-centered, stakeholder-inclusive design approaches, along with reporting on the design activities in a systematic and comprehensive manner. The gaps in knowledge were identified on the working mechanisms of intervention components and the right timing and frequency of coaching.
Evaluation of Clinical Course in Children and Adolescents with Atrial Septal Defects

Background Atrial septal defects (ASDs) are the most common third congenital heart defects. This study aimed to evaluate the clinical course of ASDs and the relationship between its complications, location closure and size. Materials and Methods: This cross-sectional study was conducted in the cardiac center of the pediatric ward in Zahedan, Iran. The study was carried out on 529 children with ASD between 2003 and 2018. The ASD children underwent echocardiography and complete examination such as physical exams, ECG and chest X-ray at every visit during follow-up. A diagnosis of ASDs was confirmed by a transthoracic echocardiography. A unique cardiologist applied transthoracic echocardiography to get information about size, location, and the number of the defects as well as hemodynamic information such as pulmonary artery pressure and any associated lesions. The data were analyzed using SPSS software version 20.0. Results: From 529 ASD children, 278 (52.5%) were girls. Most were medium (46.1%). 44.2% were closed by surgery; about 90.9% were secundum. 133 closed spontaneously and 14.6% by device. ASDs size had significant association with closure, location, and complication (P<0.001). The sinus venosus occurred in 29 patients, of which 62.07% and 37.93% were medium and large, respectively. PH was observed in nine children, 88.89% were large. ASD closure had significant association with location, and complication (P<0.001). From secundums, surgery and occluder devices closed 40.75% and 15.80, respectively. From those closed by surgery, 8.12% had residuals, 10.26% were partial anomalous pulmonary venous connection (PAPVC) as comorbidities, and 3.42% had pulmonary hypertension. Conclusion: From the study concluded ASDs size had significant association with closure, location, and complication and ASDs closure had significant association with location and complication.
Oral Cancer and Some Epidemiological Factors : A Hospital Bases Study

Research Question: What is the profile of oral cancer cases reported in the hospital? Objective : To study the profile of the oral cancer cases associated with it. Study Design: Cross-sectional study Setting : Government Dental College and Hospital, Nagpur Participants : 80 cases of oral cancer reported in the Government Dental College and Hospital Nagpur during 1998-2000 Study Variables : Demographic characteristics, oral cancer characteristics, tobacco use Statistical Analysis: percentages, proportions Results : Majority of the subjects included in the study belonged to 51-60 years age group. Most of the subjects belonged to lower middle and upper lower socio-economic scale according to modified Kuppuswamy’s socio-economic scale. It was found that the 57 (71.3%) subjects consumed tobacco in the form of betel quid or khaini and 31 (63.3%) males were tobacco smokers in the form of cigarettes and bidis. Alveolus was the common site of oral cancer being present in 55% of the subjects. Histo-pathologically 22 cases were diagnosed as verrucous carcimonma, 27 cases as well differentiated squamous cell carcinoma, 16 cases as moderately differentiated squamous cell carcimonma and 15 cases as poorly differentiated squamous cell carcinoma, 16 cases as moderately differentiated squamous cell carcinoma and 15 cases as poorly differentiated squamous cell carcinoma. Conclusion: In the present study, majority of the cases were squamous cell carcinomas and were presented in the advanced stages of the disease.
Li-Fraumeni Syndrome: Adopting a Diagnosis with an Unknown Family History

Introduction : Li-Fraumeni Syndrome (LFS) is a rare, autosomal dominant disease that is typically screenedfor and identified in patients with a known history of cancer and family history ofcancer. Presentation of Case: Ms. DA is an adopted 39-year-old South American female with a past medical history of iron deficiency anemia, celiac disease, and polio. She presented with ductal carcinoma in-situ with spindle cell atypia at age 35 and leiomyosarcoma of the ankle at age 36. Genetic counseling was offered due to her age and cancer types, with subsequent genetic testing revealing a TP53-R337H mutation, which was diagnostic of LFS. Given her high risk status, extensive cancer screenings at common LFS body sites were recommended, but she was lost to follow-up. Four years later, she returned after discovering a new right breast mass on self-examination. She was referred to a new breast surgeon, who was able to establish consistent and close follow-up while providing counseling and education regarding lifetime risk and cancer trajectory of classical LFS compared to the Brazilian LFS-subtype. Conclusion: The importance of having a high level of suspicion for patients with anunknown family history is crucial as seen in this case. Without a biological familyhistory, clinicians rely on their judgement to decide when further work-up is warranted.Advancements in medicine and genetic testing have increased the ability to accuratelydiagnose genetic diseases to help patients make life-saving decisions about theirhealth.
Depression in patients with fungal infection in tertiary care hospital

Objective To document the incidence of depression in patients who have fungal infections in tertiary care hospitals of Karachi. Design Cross sectional study. Settings Tertiary general hospital. Methods The study was initiated in the dermatology outpatient department of a tertiary general hospital after committee permission from November 2017 to April 2018. In this study the patients were recruited through convenience sampling and the inclusion criteria was patients diagnosed as having cutaneous and/or mucosal fungal infection by the consultant dermatologist after clinical evaluation and skin/mucosal biopsy with a confirmation of the same on histological report. Patients not willing to participate in the study were excluded. All the patients were informed about the nature of study and its applications and verbal informed consent was obtained from patients who were willing to participate in the study. Data collection was done in 350 patients having fungal infections out of which 219 have contagious fungal infections. Results Total 62.57% patients had contagious fungal infections, 36.57% had depression, 40.28% patients had altered social behavior, 14.28% were associated with comorbids, 20% were on medicine and 41.14% patients had previous fungal infections. Conclusion This study showed that cutaneous and mucocutaneous fungal infections affects the quality of life of people, their social and professional life.
A Genome-Wide Association Study of the Frailty Index Highlights Synaptic Pathways in Aging

Frailty is a common geriatric syndrome, strongly associated with disability, mortality and hospitalisation. The mechanisms underlying frailty are multifactorial and not well understood, but a genetic basis has been suggested with heritability estimates between 19 and 45%. Understanding the genetic determinants and biological mechanisms underpinning frailty may help to delay or even prevent frailty. We performed a genome-wide association study (GWAS) of a frailty index (FI) in European descent participants from UK Biobank (n=164,610, aged 60-70 years). FI calculation was based on 49 self-reported items on symptoms, disabilities and diagnosed diseases. We identified 26 independent genetic signals at 24 loci associated with the FI (p<5*10−8). Many of these loci have previously been associated with traits such as body mass index, cardiovascular disease, smoking, HLA proteins, depression and neuroticism; however, three appear to be novel. The estimated single nucleotide polymorphism (SNP) heritability of the FI was 14% (0.14, SE 0.006). A genetic risk score for the FI, derived solely from the UK Biobank data, was significantly associated with FI in the Swedish TwinGene study (n=10,616, beta: 0.11, 95% CI: 0.02-0.20, p=0.015). In pathway analysis, genes associated with synapse function were significantly enriched (p<3*10−6). We also used Mendelian randomization to identify modifiable traits and exposures that may affect the risk of frailty, with a higher educational attainment genetic risk score being associated with a lower risk of frailty. Risk of frailty is influenced by many genetic factors, including well-known disease risk factors and mental health, with particular emphasis on synapse maintenance pathways.
Procedures and Challenges of Adapting an Existing Public Health Intervention for Use in Another Setting: The ToyBox-Scotland Preschool Obesity Prevention Program

Childhood obesity is a major public health issue, which is reflected in the high number of interventions which have been developed to target the behaviors which cause obesity in childhood such as a lack of physical activity, poor diet, and sedentary behavior. The ToyBox programme was originally developed and tested in mainland Europe, and has now been adapted for use in Scottish preschools. This case describes the systematic approach that was taken to adapt the ToyBox programme. The intervention mapping protocol was used to guide the adaptation process in the absence of guidelines for adapting existing interventions. A Co-creation approach was used to involve stakeholders in intervention adaptation procedures. Preschool practitioners participated in workshops, where proposed intervention components were discussed and agreed upon. Proposed intervention activities were trialed out in a volunteer preschool, and an experienced preschool practitioner assisted in the adaptation of classroom materials, intervention content, and methods of delivery in order align the intervention with Scottish preschool practice. The adaptations resulted in the ToyBox-Scotland intervention being significantly different from the original European programme, whereby two major components of the original intervention were removed, and substantial adaptations were made to the delivery and content of the remaining components. Involving stakeholders in the adaptation of an existing intervention is important to ensure the programme is suitable for those who will be delivering and receiving it. However, it is currently unclear as to how much adaptation should be undertaken, highlighting the need for the creation of evidence-based guidelines for intervention adapters.
The development and application of clinically based assays for the detection of cartilage turnover

Arthritis is characterised by progressive damage of the articular cartilage. More sensitive methods than traditional radiological measures and clinical indices of disease are needed. Biochemical markers of cartilage turnover have been proposed. Few biochemical assays have been validated for reproducibility and sensitivity. Differences between large disease populations need to be determined. Enzyme-linked immunosorbent assays (ELISAs) utilising monoclonal antibodies (MAb) specific for epitopes of a major component of cartilage, aggrecan, have been developed and addressed these criteria. Differences in aggrecan cleavage by aggrecanases and matrix metalloproteinases (MMPs) within disease groups and within different areas within cartilage from patients with osteoarthritis (OA) have also been analysed. The major findings of this thesis are as follows: • Sensitive and reproducible 3B3(-) ELISAs were developed to detect cartilage turnover. Serum from patients with rheumatoid arthritis (RA) and OA had significantly higher 3B3(-) levels than controls, suggesting cartilage turnover in patients was increased. • Two aggrecan fragment populations containing the 3B3(-) epitope were found in serum from subjects with different diseases, suggesting differences in enzyme cleavage. • Sensitive and reproducible 7D4 ELISAs were developed to detect aggrecan synthesis. 7D4 epitope levels did not appear to have a genetic influence. There was a weak positive correlation between osteophytes and 7D4 epitope levels. Early RA serum 7D4 epitope levels were significantly lower than control levels. These findings suggest the 7D4 ELISA can be used to monitor patient aggrecan synthesis.
Relevanz des Stimmfeldes für Diagnostik und Therapieevaluation

Dieser Artikel diskutiert den aktuellen Forschungsstand zur Stimmfeldmessung als Untersuchungsinstrument in der Diagnostik und Therapieevaluation von funktionellen Stimmstorungen. Das Stimmfeld, ein Leistungsprofil der Sing- und Sprechstimme, wird nach internationalen Richtlinien routinemasig bei Patienten erhoben. Sowohl die Aussagekraft der Messergebnisse als auch messtechnische Probleme dieser Methode werden dargestellt und kritisch evaluiert. Aufgrund von Normwerten, die an kleinen Gruppen erstellt wurden, grosen Leistungsunterschieden zwischen Stimmgesunden, sowie messtechnisch bedingten Fehlerquellen ist das Stimmfeld zur alleinigen Erfassung einer funktionellen Stimmstorung nur begrenzt aussagekraftig. Aus dem Grunde sollte eine funktionelle Stimmstorung generell mit mehreren unterschiedlichen Untersuchungsverfahren diagnostiziert und dokumentiert werden. Neben visuellen Untersuchungsmethoden kommt der strukturierten und normierten Patientenbefragung z.B. mittels Voice Handicap Index eine besondere Bedeutung zu.
Using systematic literature reviews to develop guidelines for the management of inflammatory arthritis

The vast amount of research published on clinical areas can make awareness of current data difficult. Systematic literature reviews (SLR) are performed in order to identify, appraise and summarise the available evidence relating to specific clinical questions, and form the basis of the process used to produce clinical guidelines. This thesis describes the different processes used to produce guidelines using SLR. It includes a review of the literature on imaging in the management of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) as examples. To perform the RA review, key clinical questions were generated on the role of imaging in RA, which included the use of conventional radiography (CR),ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT),dual-emission X-ray absorptiometry (DXA), digital X-ray radiogrammetry (DXR), scintigraphy and positron emission tomography (PET). A comprehensive SLR was then performed resulting in recommendations on the role of imaging in making a diagnosis of RA, detecting inflammation and damage, predicting outcome and response to treatment, monitoring disease activity, progression and remission. A similar process was used to produce recommendations in the management of JIA;however the lack of quality data meant that ‘points to consider’ were created. The thesis also considers the quality of existing recommendations with potential areas for improvement discussed. It concludes with a discussion of the overall benefit of guidelines.