Miracle-dz/UniFAR-FTUs huggingface dataset:
Meta-analysis of the efficacy of treatments for posttraumatic stress disorder.

OBJECTIVE Posttraumatic stress disorder (PTSD) is an important mental health issue in terms of the number of people affected and the morbidity and functional impairment associated with the disorder. The purpose of this study was to examine the efficacy of all treatments for PTSD. DATA SOURCES PubMed, MEDLINE, PILOTS, and PsycINFO databases were searched for randomized controlled clinical trials of any treatment for PTSD in adults published between January 1, 1980, and April 1, 2012, and written in the English language. The following search terms were used: post-traumatic stress disorders, posttraumatic stress disorder, PTSD, combat disorders, and stress disorders, post-traumatic. STUDY SELECTION Articles selected were those in which all subjects were adults with a diagnosis of PTSD based on DSM criteria and a valid PTSD symptom measure was reported. Other study characteristics were systematically collected. The sample consisted of 137 treatment comparisons drawn from 112 studies. RESULTS Effective psychotherapies included cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing (g = 1.63, 1.08, and 1.01, respectively). Effective pharmacotherapies included paroxetine, sertraline, fluoxetine, risperidone, topiramate, and venlafaxine (g = 0.74, 0.41, 0.43, 0.41, 1.20, and 0.48, respectively). For both psychotherapy and medication, studies with more women had larger effects and studies with more veterans had smaller effects. Psychotherapy studies with wait-list controls had larger effects than studies with active control comparisons. CONCLUSIONS Our findings suggest that patients and providers have a variety of options for choosing an effective treatment for PTSD. Substantial differences in study design and study participant characteristics make identification of a single best treatment difficult. Not all medications or psychotherapies are effective.
Effect of substrate modification in catheter ablation of paroxysmal atrial fibrillation: pulmonary vein isolation alone or with complex fractionated electrogram ablation.

Catheter ablation of atrial fibrillation that targets complex fractionated electrogram sites has been widely applied in the management of persistent atrial fibrillation. The clinical outcomes of pulmonary vein isolation alone and pulmonary vein isolation plus the use of complex fractionated electrogram-guided ablation (CFEA) have not been fully compared in patients with paroxysmal atrial fibrillation.This prospective study included 70 patients with symptomatic paroxysmal atrial fibrillation that remained inducible after pulmonary vein isolation. For radio-frequency catheter ablation, patients were nonrandomly assigned to a control group (pulmonary vein isolation alone, Group 1, n=35) or a CFEA group (pulmonary vein isolation plus additional CFEA, Group 2, n=35). The times to first recurrence of atrial tachyarrhythmias were compared between the 2 groups.In Group 2, CFEA rendered atrial fibrillation noninducible in 16 patients (45.7%) and converted inducible atrial fibrillation into inducible atrial flutters in 12 patients (34.3%). Atrial fibrillation remained inducible in 7 patients (20%) after the combined ablation procedures. After a mean follow-up of 23 months, freedom from recurrence of atrial tachyarrhythmias was significantly higher in Group 2 than in Group 1 (P=0.037). In Group 1, all of the recurrent tachyarrhythmias were atrial fibrillation, whereas regular tachycardia was the major mechanism of recurrent arrhythmias in Group 2 (atrial tachycardia or atrial flutter in 5 of 6 patients and atrial fibrillation in 1 patient). We found that CFEA after pulmonary vein isolation significantly reduced recurrent atrial tachyarrhythmia and might modify the pattern of arrhythmia recurrence in patients with paroxysmal atrial fibrillation.
Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths.

OBJECTIVE The authors report on the surgical techniques and protocol for perioperative care that have yielded a zero hospital mortality rate in 110 consecutive patients undergoing hepatectomy for hepatocellular carcinoma (HCC). The hepatectomy results are analyzed with the aim of further reducing the postoperative morbidity rate. SUMMARY BACKGROUND DATA In recent years, hepatectomy has been performed with a mortality rate of <10% in patients with HCC, but a zero hospital mortality rate in a large patient series has never been reported. At Queen Mary Hospital, Hong Kong, the surgical techniques and perioperative management in hepatectomy for HCC have evolved yearly into a final standardized protocol that reduced the hospital mortality rate from 28% in 1989 to 0% in 1996 and 1997. METHODS Surgical techniques were designed to reduce intraoperative blood loss, blood transfusion, and ischemic injury to the liver remnant in hepatectomy. Postoperative care was focused on preservation and promotion of liver function by providing adequate tissue oxygenation and immediate postoperative nutritional support that consisted of branched-chain amino acid-enriched solution, low-dose dextrose, medium-chain triglycerides, and phosphate. The pre-, intra-, and postoperative data were collected prospectively and analyzed each year to assess the influence of the evolving surgical techniques and perioperative care on outcome. RESULTS Of 330 patients undergoing hepatectomy for HCC, underlying cirrhosis and chronic hepatitis were present in 161 (49%) and 108 (33%) patients, respectively. There were no significant changes in the patient characteristics throughout the 9-year period, but there were significant reductions in intraoperative blood loss and blood transfusion requirements. From 1994 to 1997, the median blood transfusion requirement was 0 ml, and 64% of the patients did not require a blood transfusion. The postoperative morbidity rate remained the same throughout the study period. Complications in the patients operated on during 1996 and 1997 were primarily wound infections; the potentially fatal complications seen in the early years, such as subphrenic sepsis, biliary leakage, and hepatic coma, were absent. By univariate analysis, the volume of blood loss, volume of blood transfusions, and operation time were correlated positively with postoperative morbidity rates in 1996 and 1997. Stepwise logistic regression analysis revealed that the operation time was the only parameter that correlated significantly with the postoperative morbidity rate. CONCLUSION With appropriate surgical techniques and perioperative management to preserve function of the liver remnant, hepatectomy for HCC can be performed without hospital deaths. To improve surgical outcome further, strategies to reduce the operation time are being investigated.
Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer.

PURPOSE To evaluate the impact of subsequent pregnancy on the prognosis of patients with early breast cancer. PATIENTS AND METHODS One hundred eight patients who became pregnant after diagnosis of early-stage breast cancer were identified in institutions participating in International Breast Cancer Study Group (IBCSG) studies. Fourteen had relapse of breast cancer before their first subsequent pregnancy. The remaining 94 patients (including eight who relapsed during pregnancy) formed the study group reported here. A comparison group of 188 was obtained by randomly selecting two patients, matched for nodal status, tumor size, age, and year of diagnosis from the IBCSG database, who were free of relapse for at least as long as the time between breast cancer diagnosis and completion of pregnancy for each pregnant patient. Survival comparison used Cox proportional hazards regression models. RESULTS Overall 5- and 10-year survival percentages (+/- SE) measured from the diagnosis of early-stage breast cancer among the 94 study group patients were 92% +/- 3% and 86% +/- 4%, respectively. For the matched comparison group survival was 85% +/- 3% at 5 years and 74% +/- 4% at 10 years (risk ratio, 0.44; 95% confidence interval, 0.21 to 0.96; P =.04). CONCLUSION Subsequent pregnancy does not adversely affect the prognosis of early-stage breast cancer. The superior survival seen in this and other controlled series may merely reflect a healthy patient selection bias, but is also consistent with an antitumor effect of the pregnancy.
Management of painful bone metastases

Purpose of review This review examines recent data on the pathophysiology and mechanisms of bone pain; it highlights the use of multiple and interdisciplinary treatments rather than sole use of traditional analgesics. Recent findings Bone pain has been shown to have a unique pathophysiology. Recent experimental (animal) models have revealed that, parallel to increased bone destruction, ipsilateral spinal cord segments that receive primary input from the cancerous femur exhibit several notable neurochemical changes. These mandate the use of opioid doses sufficient to inhibit the observed nociceptive behaviours; these doses are greater than those required to alleviate pain behaviours of comparable magnitude generated by inflammatory pain. Several substances have been tested in this animal model. Summary According to new preclinical data, treatment of bone cancer pain requires multidisciplinary therapies such as radiotherapy applied to the painful area along with systemic treatment (hormone therapy or chemotherapy) and supportive care (analgesic therapy and bisphosphonates). In some selected cases use of radioisotopes and other noninvasive or minimally invasive techniques may be useful in the management of metastatic bone pain. The treatment should be individualized according to the patient's clinical condition, life expectancy, and quality of life.
Lung delivery of non-CFC salbutamol via small volume metal spacer and large volume plastic spacer devices compared with an open vent jet nebulizer.

AIMS To compare the lung delivery of salbutamol from a commonly used constant output open vent jet nebuliser (Sidestream) with use of both a conventional large volume plastic spacer (Volumatic) and a novel small volume metal spacer (NebuChamber). This was assessed using the early lung absorption profile of salbutamol over the first 20 min after inhalation. METHODS Twelve healthy volunteers were studied in a randomized single (investigator) blind crossover design. Single 1200 microg nominal doses salbutamol from a CFC-free metered-dose inhaler (12 sequential 100 microg puffs of Airomir) were delivered via the Volumatic and NebuChamber spacers. A single 1200 microg nominal dose of salbutamol was given as a 4 ml fill volume from a Sidestream nebuliser with mouthpiece. Mouth rinsing was performed after each drug sequence. Plasma salbutamol was measured at 5, 10, 15 and 20 min after the last dose of each inhalation sequence, with calculation of maximal concentration (Cmax) and average concentration over 20 min (C[av]). Systemic beta2-responses were measured as plasma potassium, tremor and heart rate. RESULTS Both the Volumatic and the NebuChamber spacers produced significantly greater salbutamol concentration than the Sidestream nebuliser. For C(av) this amounted to a 7.34-fold difference (95%CI 5.31 to 9.38) between Volumatic vs Sidestream, and a 7.04-fold difference (95%CI 4.91 to 9.17) for NebuChamber vs Sidestream. Similar differences were found for the extrapulmonary beta2-responses. There were no significant differences in either salbutamol concentration or extrapulmonary beta2-responses between the Volumatic and NebuChamber spacers. CONCLUSIONS We found that, in vivo, both the Volumatic and the NebuChamber spacers produced seven-fold greater lung delivery of salbutamol than the Sidestream nebuliser when comparing microgram equivalent nominal doses, in terms of the early lung absorption profile.
Refining exposure definitions for studies of periodontal disease and systemic disease associations.

BACKGROUND Substantial variation exists in reported associations between periodontal infections and cardiovascular disease. Imprecise periodontal exposure definitions are possible contributors to this variability. We studied appropriate exposure definitions for studying associations between clinical periodontal disease (PD) and systemic disease. METHODS Data originate from men and women aged 20-79 enrolled in the Study of Health in Pomerania (SHIP) from 1997-2001. Age and sex-adjusted correlation analysis identified PD definitions with the highest cross-sectional associations with three subclinical markers of systemic disease: plasma fibrinogen (n = 3481), serum hemoglobin A1c (HbA1c) (n = 3480), and common carotid artery intima-media thickness (c-IMT) (n = 1745, age > or = 45). RESULTS In men and women, percent of sites with attachment loss (AL) > or =6 mm and tooth loss both revealed the highest correlation with HbA1c (rho = 0.11; several other definitions related similarly), while the strongest fibrinogen correlation was observed with percent of sites with pocket depth > or =3 mm (rho = 0.19). Findings for c-IMT among men were strongest for percent of sites with AL > or =6 mm (rho = 0.14; several other definitions related similarly) while among women, percent of sites with pocket depth > or =5 or 6 mm had the highest observed correlation (rho = 0.13). CONCLUSIONS A range of near optimal definitions varied according to gender and whether the systemic disease marker reflected an acute or chronic situation. Pocket depth was more strongly correlated with the acute marker fibrinogen while attachment and tooth loss tended to be more strongly correlated with the chronic markers, HbA1c, and c-IMT. These findings can be useful in designing future studies investigating the association between PD and systemic disease.
Immediate implant placement and provisional crown fabrication after a minimally invasive extraction of a peg-shaped maxillary lateral incisor: a clinical report.

AIM The aim of this case report is to describe the replacement of a maxillary peg-shaped lateral incisor with the placement of an immediate implant and a provisional restoration following a minimally invasive extraction to preserve anterior esthetics. BACKGROUND Extraction sites in the anterior maxilla can present restorative challenges with regard to esthetics. Resistance to wearing a temporary removable partial denture during healing makes immediate implant therapy an appealing alternative to patients. Implant placement into fresh extraction sockets using no flap elevation has recently become more popular due to some advantages including less bleeding, swelling, and the preservation of existing soft tissue contours. CASE REPORT A 20-year-old woman with a peg-shaped maxillary left lateral incisor was treated using an implant placed into the fresh extraction socket using a flapless approach and immediate provisional crown fabrication. Flapless implant placement helps to preserve site morphology by protecting and supporting existing hard and soft tissues while minimizing surgical trauma to the adjacent tissues. Using a previously fabricated acrylic index, a provisional acrylic crown was fabricated on the adjusted temporary abutment and delivered to the patient the same day during the extraction visit. SUMMARY This report describes the diagnosis and treatment of an over-prepared peg-shaped maxillary left lateral incisor associated with multiple crown decementations. The tooth was extracted without flap elevation and an implant was inserted immediately using flapless surgery and placement of an immediate provisional single crown. CLINICAL SIGNIFICANCE Flapless implant insertion into fresh extraction sockets and placement of immediate provisional crowns in cases involving the maxillary anterior region represent a viable treatment option in appropriate clinical situations where esthetics are a high priority. The strategy preserves optimum gingival contours and papillary height may be a viable option compared to fixed partial dentures.
Epithelial influences on membrane bone formation in the maxilla of the embryonic chick

In light of previous evidence that epithelial influences are required for membrane bone formation in certain instances (mandible, Tyler and Hall, '77 a,b; cranium, Benoit and Schowing, '70), the possibility that maxillary epithelium influences membrane bone formation within the maxillary mesenchyme was investigated. Intact maxillary processes, and enzymatically separated epithelial and mesenchymal components of the maxilla were obtained from embryonic chicks of three to five days of incubation (Hamburger and Hamilton ['51] stages (HH) 18‐25) were grown individually as grafts on the chorioallantoic membranes of host chick embryos. The histodifferentiation of grafted intact maxillary processes was similar to that in vivo. The histodifferentiation of grafted maxillary mesenchyme depended upon the embryonic age at which the mesenchyme was isolated from its epithelium. In grafts of maxillary mesenchyme isolated from its epithelium at HH 22 or earlier stages, cartilage differentiated, but membrane bone did not form. In grafts of maxillary mesenchyme isolated from its epithelium at HH 23 or later stages, membrane bone formed in addition to cartilage. The results indicate that maxillary mesenchyme requires the presence of epithelium through HH 22 in order for membrane bone to form within the mesenchyme. Cartilage formation within the mesenchyme does not require epithelial influences during the embryonic period tested (HH 18‐25). Maxillary epithelium isolated from its mesenchyme and grown as a graft became underlaid by host fibroblasts and achieved a limited degree of differentiation; the epithelium did not induce ectopic membrane bone formation within the host tissue, indicating that the presence of maxillary epithelium is not a sufficient condition for promoting membrane bone formation in normally non‐osteogenic tissue.
Therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease

Object. To explore the therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease (MMD). Methods. We used a modified multiple burr hole operation, combined with dural inversion and periosteal synangiosis, in a series of 57 patients with ischemic-type MMD as a sole revascularization procedure. Postoperatively these patients were followed up for 6 months to 3 years. Results. The postoperative clinical outcomes were excellent for 24 patients (42.1%), good for 21 patients (36.8%), fair for 9 patients (15.8%), and poor for 3 patients (5.3%). There was a significant difference between the preoperative and postoperative modified Rankin Scale or mRS scores. The postoperative angiography revealed that there was sufficient neovascularization at 151 of the 160 burr holes. Effective neovascularization was not found at 9 burr holes in 4 patients. The neovascularization derived mainly from the superficial temporal artery and middle meningeal artery, and less from the posterior auricular artery, occipital artery, and deep temporal artery. The postoperative complications included one case of subdural hematoma, one case of subdural effusions, and five cases of postoperative temporary neurological deficits. Conclusion. The multiple burr-hole operation combined with dural inversion and periosteal synangiosis is a simple, safe, and effective treatment for ischemic-type MMD as a sole treatment without supplementary revascularization procedures.
esenchymal stem cells enhance lung cancer initiation through activation of L6 / JAK 2 / STAT 3 pathway an -

Background: The role of mesenchymal stem cells (MSCs) and IL-6 in lung cancer has not been welladdressed. We aimed to determine if MSCs can enhance the ability of tumor initiation of lung cancer cells, and link MSCs with activation of the IL-6/JAK2/STAT3 signaling pathway. Materials and methods: Lung cancer cell lines A549 and CL1-5 were directly or indirectly cocultured with MSCs. Spheres were defined as cell colonies with >50% area showing 3-dimensional structure and blurred cell margins. Cells without and with MSCs were injected into NOD/SCID mice. The percentage of tumor formation was determined. The influence of the IL-6/JAK2/STAT3 signaling pathway in cancer cell sphere formation and tumor growth were investigated. Results: A very small number of lung cancer cells, when mixed with otherwise non-tumorigenic MSCs, obtained de novo tumorigenicity when injected subcutaneously and allowed to form a tumor xenograft. Secretion of IL-6 from MSCs increased activation of the JAK2/STAT3 pathway in cancer cells, and enhanced sphere formation and tumor initiation. A reduced capacity of tumor formation of A549 and CL1-5 lung cancer cells when IL-6 was inhibited in MSCs or STAT3 was silenced in A549 and CL1-5 admixed with MSCs. Conclusions: Culture of A549 or CL1-5 lung cancer cells with MSCs increased sphere formation, drug resistance, and overexpression of pluripotency markers through activation of the IL-6/JAK2/STAT3 pathway. MSCs enhanced the capability of A549 and CL1-5 lung cancer cells to form tumors in immunodeficient mice. Blockade of the IL-6/JAK2/STAT3 pathway attenuated the capability of A549 and CL1-5 cells to form tumors.
Experiences of Swedish children with disabilities: activities and social support in daily life

Aim: The purpose of this study was to describe experiences of everyday activities and social support in daily life in children with disabilities. Method: Interviews were conducted with 33 children (14 girls and 19 boys, aged 7–13 years) with physical, intellectual, or neuro-psychiatric disability. Interviews were analysed using qualitative content analysis. Results: In many ways, the children described themselves as being like any other child or adolescent. Their narratives showed that they had developed strategies to cope with the consequences of their disability, both socially and in the performance of daily activities. The children received social support in everyday activities, mainly from their family and close friends. Meeting other children with the same disability supported opportunities for identification. However, their experiences of everyday activities were in many cases associated with sadness, especially when they could not participate in activities with their peers. Conclusions: According to the children's statements, it is important for people close to these children, both habilitation staff and others, to take responsibility for improving emotional, informative, and instrumental support in order to enable the children to perform and participate in everyday activities.
Intensive Care in the Adult With Congenital Heart Disease

Objectives: The purpose of this review is to discuss current outcomes for patients with adult congenital heart disease, assess the level of knowledge regarding the impact of comorbidities, and discuss the various models of care with a view to establish the optimal environment for the care of these patients in the future. Data Source: MEDLINE and PubMed. Conclusion: There is an increasingly large population of adults with previously operated congenital heart disease. Consequently, there are increasing numbers of adults requiring intensive care support after re-do surgery, or as a consequence of medical complications of their underlying cardiac disease. There is relatively little data specific to this population to guide optimal disposition and care models.