Miracle-dz/UniFAR-FTUs huggingface dataset:
Cost-effectiveness of Dalteparin Versus Unfractionated Heparin as Venous Thromboembolism Prophylaxis in Malignant Gynecologic Surgery

Venous thromboembolic events (VTEs) are serious complications that may occur in the patient undergoing surgery for gynecologic malignancies. The American College of Chest Physicians recommends unfractionated heparin or low-molecular weight heparin as prophylaxis for deep vein thrombosis and pulmonary embolism in this patient population. Cost-effectiveness analyses comparing unfractionated heparin 3 times a day versus once daily dalteparin using published efficacy and safety data demonstrate cost savings if dalteparin were routinely utilized as VTE prophylaxis. Sensitivity analyses support this finding at the upper end of the range of reported proximal DVT, nonfatal pulmonary embolism, and major bleeding incidences. These findings should be viewed as preliminary, and institutions are encouraged to perform their own cost-effectiveness studies in this patient population.
Biomechanical evaluation of a microstructured zirconia implant by a removal torque comparison with a standard Ti-SLA implant.

OBJECTIVES The purpose of this study was to evaluate the biomechanical bone tissue response to novel microstructured zirconia implants in comparison to sandblasted and acid-etched (SLA) titanium implants through the analysis of removal torque (RTQ) measurements. MATERIALS AND METHODS Ti-SLA implants with a sandblasted, large-grit and acid-etched surface were compared with zirconia implants with an acid-etched surface. All implants had the same shape, a diameter of 4.1 mm and a length of 10 mm. A total of 136 implants were placed in the maxillae of 17 miniature pigs. Six animals were sacrificed after both 4 and 8 weeks and five animals were sacrificed after 12 weeks, thus providing a total of 102 implants for RTQ testing (34 implants were reserved for future histological analysis). The RTQ analysis was successfully performed, using a mixed model regression with P-values calculated using the nonparametric Brunner-Langer method, on 100 of the 102 implants, two were excluded from the analysis. RESULTS The adjusted mean RTQ values for Ti-SLA implants were 131 Ncm (95% CI: 107-155) at 4 weeks, 128 Ncm (108-148) Ncm at 8 weeks, and 180 Ncm (153-207 Ncm) at 12 weeks of healing, whereas RTQ values for the zirconia implants were 110 Ncm (86-134), 97 Ncm (76-118) and 147 Ncm (121-174) at the corresponding time intervals. A comparison of the implant materials resulted in P-values of P = 0.114 at 4 weeks, P = 0.034 at 8 weeks and P = 0.105 at 12 weeks (significance set at P < 0.05). CONCLUSIONS Within the limits of the present study, it could be confirmed that the biomechanical bone-tissue response of the investigated zirconia implants is non-inferior to that of the well-documented, roughened titanium surface, at each time point, within the set tolerance. There were no statistically significant differences between the two materials after a healing period of 4 and 12 weeks. The RTQ values of both implant types increased significantly from the 8-week to the 12-week time point.
Evidence-based knowledge on the biology and treatment of extraction sockets.

OBJECTIVES The fresh extraction socket in the alveolar ridge represents a special challenge in everyday clinical practice. Maintenance of the hard and soft tissue envelope and a stable ridge volume were considered important aims to allow simplifying subsequent treatments and optimizing their outcomes in particular, when implants are planned to be placed. MATERIAL AND METHODS Prior to the consensus meeting four comprehensive systematic reviews were written on two topics regarding ridge alteration and ridge preservation following tooth extraction and implant placement following tooth extraction. During the conference these manuscripts were discussed and accepted thereafter. Finally, consensus statements and recommendations were formulated. RESULTS The systematic reviews demonstrated that the alveolar ridge undergoes a mean horizontal reduction in width of 3.8 mm and a mean vertical reduction in height of 1.24 mm within 6 months after tooth extraction. The techniques aimed at ridge preservation encompassed two different approaches: i) maintaining the ridge profile, ii) enlarging the ridge profile. Regarding timing of implant placement the literature showed that immediate implant placement leads to high implant survival rates. This procedure is primarily recommended in premolar sites with low esthetic importance and favorable anatomy. In the esthetic zone, however, a high risk for mucosal recession was reported. Hence, it should only be used in stringently selected situations with lower risks and only by experienced clinicians. In molar sites a high need for soft and hard tissue augmentation was identified. CONCLUSIONS Future research should clearly identify the clinical and patient benefits resulting from ridge preservation compared with traditional procedures. In addition, future research should also aim at better identifying parameters critical for positive treatment outcomes with immediate implants. The result of this procedure should be compared to early and late implant placement.
Deciphering the complex: Methodological overview of statistical models to derive OMICS‐based biomarkers

Recent technological advances in molecular biology have given rise to numerous large‐scale datasets whose analysis imposes serious methodological challenges mainly relating to the size and complex structure of the data. Considerable experience in analyzing such data has been gained over the past decade, mainly in genetics, from the Genome‐Wide Association Study era, and more recently in transcriptomics and metabolomics. Building upon the corresponding literature, we provide here a nontechnical overview of well‐established methods used to analyze OMICS data within three main types of regression‐based approaches: univariate models including multiple testing correction strategies, dimension reduction techniques, and variable selection models. Our methodological description focuses on methods for which ready‐to‐use implementations are available. We describe the main underlying assumptions, the main features, and advantages and limitations of each of the models. This descriptive summary constitutes a useful tool for driving methodological choices while analyzing OMICS data, especially in environmental epidemiology, where the emergence of the exposome concept clearly calls for unified methods to analyze marginally and jointly complex exposure and OMICS datasets. Environ. Mol. Mutagen. 54:542‐557, 2013. © 2013 Wiley Periodicals, Inc.
Blood pressure management in acute intracerebral hemorrhage

Primary intracerebral hemorrhage (ICH) results from spontaneous rupture of an intracranial vessel and is associated with high rates of early mortality and long-term morbidity. No surgical or medical intervention has been demonstrated to improve outcome. Acute blood pressure elevation is seen in the majority of patients with ICH and is correlated with poor outcome. Potential, but unproven, mechanisms for this association include facilitation of hematoma expansion as well as perihematomal edema growth. Conversely, the perihematomal region has also been hypothesized to have ischemic properties. Therefore, management of blood pressure in the acute phase lends itself to two competing rationales and the optimal target blood pressure remains unknown. A number of parenchymal and blood-flow imaging techniques have been utilized to improve our understanding of blood flow and metabolism in acute ICH. These studies generally indicate that ischemia is not a major pathophysiological mechanism of secondary injury in ICH.
An Evaluation of Turn Around Times (TAT) in The Clinical Pathology Laboratory of A Referral Hospital and Root Cause Analysis of Delay in Despatch of Reports

INTRODUCTION: Clinical laboratory testing is an essential element in the delivery of health care services [1,2]. The dependence of patient management on laboratory data highlights the need for ensuring the quality of these services [1,2]. Delays in reporting laboratory results can cause a concomitant delay in the diagnosis and management of patients [3]. The Joint Commission has underlined this fact by stating that the laboratory is required to systematically assess and improve important functions and work processes and their outcomes [4].
Probing at implants with peri-implantitis and its relation to clinical peri-implant bone loss.

OBJECTIVES To evaluate the probing depth at implants with signs of peri-implantitis before and following the removal of the prosthetic reconstructions and its relation with the peri-implant bone level as revealed by open access flap surgery. MATERIAL AND METHODS Twenty-nine patients with 89 implants with diagnosis of peri-implantitis were included in the study. The probing pocket depth at implants before (PPD-1) and following (PPD-2) the removal of the prosthetic reconstructions was measured at four sites of the implants. These measurements were also analysed in relation to the amount of peri-implant bone loss measured during peri-implant surgery. RESULTS The results showed that in only 119 (37%) of the sites, the measurements were similar between PPD-1 and PPD-2; in 124 sites (39%), the difference was ±1 mm, in 47 sites (15%) it was ±2 mm and in the rest of the sites it was ±3 mm. A high linear and statistically significant (P = <0.001) correlation between PPD-2 and the bone loss measured at implants for all and single surfaces was observed (r = 0.67, range 0.64-0.69), while PPD-1 yielded a weak and no statistically significant correlation (r = 0.35, range 0.27-0.42). The analysis of the bone loss at implants showed that 59 implants (66%) had an amount of bone loss that was similar at all the four surfaces, while in 30 implants, the bone loss differed for the various sites. A higher extent of bone loss was often detected at the buccal compared with the other sites. CONCLUSION The results of this study yielded differences in the pocket probing measurements at implants with or without the prosthetic reconstruction in place and that the probing pocket depth following the removal of the prosthesis had a high correlation with the amount of bone loss at implants assessed during surgery.
Validation Of The Sentence Repetition Test As A Measure Of Suspect Effort

It has been suggested that the Sentence Repetition Test (SRT) could serve as an adequate embedded symptom valid ity measure identifying suspect effort during neuropsychological testing. However, very little research has examined sensitivity and specificity rates when using this measure in a variety of clinical settings. The SRT was administered to 1031 patients referred for neuropsychological assessment in outpatient, inpatient, and independent medical evaluation settings. These patients were diagnosed with a wide range of psychiatric, developmental, and neurological disorders. The results of this study reveal that the SRT is a valid measure of suspect effort for the vast majority of these patients (sensitivity = 56.8% and specificity = 95.8% in combined clinical settings). However, analyses also indicate that the SRT is not a valid effort measure for individuals with mental retardation or dementia due to specificity rates falling well below 90% for both groups. Furthermore, the validity of the SRT as an effort measure is questionable for individuals with English as a second language, with a verbal learning disability, with a left cerebrovascular accident, or with an expressive-receptive language disorder due to small sample sizes or borderline specificity rates. Sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy rates are provided for varying cutoff scores in inpatient, outpatient, and IME settings. The results of this extensive study confirm that the SRT can be a useful measure in detecting suspect effort in neuropsychological testing while also providing valuable clinical information.
Short-term complications of implant-supported and combined tooth-implant-supported fixed dental prostheses.

OBJECTIVE The objective of this clinical study was to evaluate survival and incidence of complications for metal-ceramic and all-ceramic implant-supported fixed dental prostheses (FDPs) and tooth-implant-supported FDPs. MATERIAL AND METHODS One-hundred and sixty-six FDPs placed in 132 patients from a prospective study were selected for this retrospective analysis. Included were 91 conventional implant-supported FDPs with implant support on both extremities, 27 implant-supported cantilever FDPs, and 48 tooth-implant-supported FDPs. All restorations were veneered with ceramic. Twenty-six FDPs had a zirconia framework and 140 had a metal framework. Kaplan-Meier analysis was performed to estimate FDP success defined as complication-free survival and the Cox regression model was used to isolate risk factors for the most frequent complications. RESULTS Within a median follow-up of 1 year and 2 months, three failures were caused by a failed implant (n = 2) and by extended chipping of the veneer (n = 1). In contrast with this low incidence of failure was a high incidence of complications including chipping (n = 29), loss of retention (n = 35), and abutment fractures (n = 2). Multivariate survival analysis revealed a significantly greater incidence of chipping for males and a tendency to increased incidence of chipping for zirconia-based FDPs. The incidence of loss of retention tended to be less for tooth-implant-supported FDPs, for which semi-permanent cement was the only significant risk factor, with a hazard ratio of almost 5. CONCLUSIONS As chipping of the ceramic veneer was the most frequent complication leading to substantial aftercare, improvements of ceramic veneers are desirable for zirconia-based and metal-based FDPs.
Use of the WAIS-III Picture Completion Subtest as an Embedded Measure of Response Bias

In the present study a large sample of credible patients (n = 172) scored significantly higher than a large sample of noncredible participants (n = 195) on several WAIS-III Picture Completion variables: Age Adjusted Scaled Score, raw score, a “Rarely Missed” index (the nine items least often missed by credible participants), a “Rarely Correct” index (nine items correct <26% of the time in noncredible participants and with at least a 25 percentage-point lower endorsement rate as compared to credible participants), and a “Most Discrepant” index (the six items that were the most discrepant in correct endorsement between groups—at least a 40 percentage point difference). Comparison of the various scores showed that the “Most Discrepant” index outperformed all the others in identifying response bias (nearly 65% sensitivity at 92.8% specificity as compared to at most 59% sensitivity for the other scores). While no differences in Picture Completion scores were observed between less-educated (<12 years) and better-educated (≥12 years) credible participants, noncredible participants with <12 years of education scored significantly poorer than noncredible participants with 12 or more years of education. On the “Most Discrepant” index, 76.7% of less-educated noncredible participants were detected as compared to 58.3% of better-educated noncredible participants. Results of the current study suggest that the Picture Completion subtest of the WAIS-III is an effective measure of response bias, and that it may have a unique role in identifying suboptimal effort in less-educated test takers.
Computerized N-Acetylcysteine Physician Order Entry by Template Protocol for Acetaminophen Toxicity

Some medication dosing protocols are logistically complex for traditional physician ordering. The use of computerized physician order entry (CPOE) with templates, or order sets, may be useful to reduce medication administration errors. This study evaluated the rate of medication administration errors using CPOE order sets for N-acetylcysteine (NAC) use in treating acetaminophen poisoning. An 18-month retrospective review of computerized inpatient pharmacy records for NAC use was performed. All patients who received NAC for the treatment of acetaminophen poisoning were included. Each record was analyzed to determine the form of NAC given and whether an administration error occurred. In the 82 cases of acetaminophen poisoning in which NAC was given, no medication administration errors were identified. Oral NAC was given in 31 (38%) cases; intravenous NAC was given in 51 (62%) cases. In this retrospective analysis of N-acetylcysteine administration using computerized physician order entry and order sets, no medication administration errors occurred. CPOE is an effective tool in safely executing complicated protocols in an inpatient setting.
Drei Jahre Erfahrung mit dem konzentrierten autogenen Fibrinkleber in der plastischen HNO-Chirurgie*

Transplantationsfahiges Gewebe ist zum Zeitpunkt der Verpflanzung hypoxisch und wird durch Diffusion die Lymphspalten des Wundbettes versorgt. Wichtige Voraussetzungen für das gute Einheilen sind neben guter Durchblutung und Infektionsfreiheit des Wundbettes eine möglichst rasche Revaskularisation sowie em guter Kontakt zwischen Transpiantat und Wundbett. Diese Anforderungen werden durch den Fibrinkleber, weicher bereits seit Jahren in der Plastischen Chirurgie verwendet wird, ideal erfüllt (2, 3, 4, 5, 6). Einzige Nachteile der handelsüblichen Fibrinkleber sind die relativ hohen Kosten und die Moglichkeit der Ubertragung von Infektionskrankheiten wie z. B. einer Virushepatitis. Wir versuchten daher einen Fibrinkleber aus patienteneigenem Fibrinogen herzustellen. Hauptproblem dabei war, em an Kosten und Zeit unaufwendiges und unkompliziertes Verfahren zu entwickeln. 1981 gelang es uns, einen autogenen Fibrinkleber aus hochkonzentriertem Fibrinogen des Patienten herzustellen (7,8). Die Vorteile dieses neuen Kiebers sind: — Es besteht keine Gefahr der Ubertragung von Infektionskrankheiten und keine Gefahr einer Immunreaktion, da autogenes Fibrinogen verwendet wird. — Die Herstellung und Applikation sind einfach und erfolgen bei Zimmertemperatur. — Die Herstellungskosten sind gering. — Seine Klebekapazität ist mit der des industriell gefertigten Kiebers vergleichbar.
Eating With the Glycemic Index in Mind: Keeping Blood Sugar Levels Down to Prevent Diabetes Mellitus and Heart Disease

Hyperglycemia and hyperinsulinemia are frequently associated with type 2 diabetes mellitus, but studies have also associated it with cardiovascular disease. More specifically, diets high in carbohydrates can have an adverse effect on serum lipid levels and glucose metabolism. Studies show high glycemic food intake over a long period of time is a significant risk factor for type 2 diabetes mellitus. A study conducted in Europe involving 3,000 participants found that those who consumed low glycemic foods had greater levels of high-density lipoprotein (HDL; good cholesterol; Toeller et al., 2001). Other studies support this association of elevated HDLs and consumption of low dietary glycemic index (GI) foods.
A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years.

OBJECTIVES The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications. METHODS An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on FDPs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year and 10-year survival and complication rates. RESULTS The updated search provided 979 titles and 257 abstracts. Full-text analysis was performed for 90 articles resulting in a total 32 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants supporting FDPs of 95.6% after 5 years and 93.1% after 10 years. When machined surface implants were excluded from the analysis and only rough surface implants included, the survival rate increased to 97.2% after 5 years. The survival rate of implant-supported FDPs was 95.4% after 5 years and 80.1% after 10 years of function. When the analysis was done exclusively for metal-ceramic FDPs, hence the old gold-acrylic FDPs were excluded, the survival rate increased significantly. The survival rate of metal-ceramic implant-supported FDPs was 96.4% after 5 years and 93.9% after 10 years. Only 66.4% of the patients were free of any complications after 5 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), peri-implantitis and soft tissue complications (8.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of cemented FDPs (4.7%). CONCLUSION It may be concluded that implant-supported fixed dental prostheses (FDPs) are a safe and predictable treatment method with high survival rates. However, biological and technical complications were frequent (33.6%). To minimize the incidence of complications, dental professionals should make great effort in choosing reliable components and materials for implant-supported FDPs and the patients should be placed in well-structured maintenance system after treatment.
Recent Advances in Prodrugs as Drug Delivery Systems

Prodrugs are a class of drug derivatives with little or no pharmacological activity that are converted in vivo to therapeutically active compounds. The primary utility of a prodrug approach is to improve pharmaceutical properties. Because it does not alter the primary structure of the parent drug, the synthesis of prodrugs is usually much less difficult than the synthesis of analogs. The derived physicochemical properties of the resulting derivatives can be carefully tailored by means of structural modification of the promoiety. However, sufficient levels of intrinsic activity of the parent drug need to be assured through in vivo cleavage of the prodrug. The prodrug approach has been successfully applied to a wide variety of drugs. This article briefly discusses advances in strategies for development of prodrugs and their mechanisms of drug release.
Baseball, Lobsters, and our Genetic Relationship to the Banana

The Academy has, as one of its major roles, a commitment to improving communication between lawyers, medical practitioners and those involved in all aspects of forensic science. In this Presidential lecture I shall attempt to demonstrate why this is necessary and how better understanding might help in the resolution of a number of differences between us, differences often dependent on the way we are trained and the way we approach contentious issues.
Preliminary Normative Neuropsychological Data for an Elderly Chinese Population

Neuropsychological testing is key to diagnosing and assessing for dementia but there is a dearth of normative neuropsychological data for ethnic Chinese older persons, particularly for non-English-speaking individuals with low education. The aim of this study was to establish a set of age-specific, education-specific, and culture-appropriate norms on measures of cognitive function for a population of cognitively normal community-dwelling Chinese elderly, and explore the effects of age and education on test performance. Results showed decreasing test performances with increasing age and very poor performance in the most poorly educated strata. However, the age-associated decline in test performance was not uniform across different education groups, indicating a more complex association. The present findings highlight a need for normative data that are applicable to lower educated elderly people as this group makes up a substantial proportion of the Asian elderly.