Miracle-dz/UniFAR-FTUs huggingface dataset:
Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD: a multicenter prospective cohort study.

BACKGROUND We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD). STUDY DESIGN Multicenter prospective study. SETTING & PARTICIPANTS 489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics. PREDICTORS Achievement of goal for ambulatory (day- and night-time BPs <135/85 and <120/70mmHg, respectively) and clinic (<140/90mmHg) BPs was used to create 4 BP groups: clinic and ambulatory BPs at goal (group 1), clinic BP above goal and ambulatory BP at goal (group 2), clinic BP at goal and ambulatory BP above goal (group 3), and clinic and ambulatory BPs above goal (group 4). OUTCOMES Composite cardiovascular event outcome (fatal and nonfatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) and a composite renal outcome (maintenance dialysis therapy or death). MEASUREMENTS Clinic and 24-hour ambulatory BPs. RESULTS Mean age was 64.4±14.2 (SD) years; 41% were women, and diabetes and previous cardiovascular disease were present in 36% and 30%, respectively. Groups 1-4 contained 16.8%, 22.1%, 14.5%, and 46.6%, respectively, of the overall number of participants. Median follow-up was 5.2 years. Compared to group 1, the adjusted risk of the composite cardiovascular outcome was higher in groups 3 (HR, 3.17; 95%CI, 1.50-6.69) and 4 (HR, 2.83; 95%CI, 1.50-5.34), but not in group 2 (HR, 1.55; 95%CI, 0.75-3.19). Similarly, the risk of the composite renal outcome was higher in groups 3 (HR, 3.59; 95%CI, 2.05-6.27) and 4 (HR, 2.96; 95%CI, 1.83-4.78), but not group 2 (HR, 1.24; 95%CI, 0.67-2.27). Sensitivity analyses confirmed that these results were independent from the thresholds used for defining groups. LIMITATIONS Only white patients were enrolled. Observational design does not allow for causality to be established. CONCLUSIONS In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal.
Avaliação dos pacientes submetidos à fixação de fraturas diafisárias do úmero pela técnica minimamente invasiva - Placa-ponte

OBJECTIVE: The aim was to describe the experience of our group in treating humeral shaft fractures using the bridge-plate technique via an anterior approach. METHODS: Seventeen patients with acute diaphyseal humeral fractures with an indication for surgical treatment who were operated in 2006-2010 were evaluated. The AO and Gustilo & Anderson classifications were used. All the patients were operated using the anterior bridge-plate technique and completed a follow-up period of at least twelve months. RESULTS: Sixteen men and one woman were treated. Their mean age was 31.8 years (18-52). Among the injury mechanisms found were: five motorcycle accidents, four car accidents, three fractures due to firearm projectiles, two falls to the ground and finally, with one case each, assault, crushing and being run over. Eight patients had open fractures: two grade I, one grade II, four grade Ilia and one grade Illb, according to the Gustilo-Anderson classification. In relation to the AO classification, we found: one 12A1, three 12A2, four 12A3, one 12B1, four 12 B2, three 12B3 and one 12C2. The mean postoperative follow-up was 25 months (12-48). As complications, two patients had pain in the elbow and a ROM deficit and one had deep infection. The mean time taken to achieve consolidation was 17.5 weeks. There was no loss of reduction, pseudarthrosis or malunion in this series of patients. CONCLUSION: The authors believe that the technique described has low rates of complications and morbidity, with good initial results, although the series is limited by the small sample.
Febuxostat for Asymptomatic Hyperuricemia in CKD.

Note: Values for continuous variables given as mean 6 standard deviation; for categorical variables, as number (percent). eGFR determined by the Modification of Diet in Renal Disease Study equation. Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; eGFR, estimated glomerular filtration rate. To the Editor: We are greatly interested in the article by Sircar et al, which demonstrates the efficacy of febuxostat in retarding estimated glomerular filtration rate decline in patients with chronic kidney disease (CKD) and asymptomatic hyperuricemia. Numerous studies have demonstrated a relationship between serum uric acid levels and cardiovascular morbid entities, including kidney diseases. Others have explored the effectiveness of conventional hypouricemic agents such as allopurinol in slowing CKD progression. This study appears to demonstrate the cause-effect relationship between hyperuricemia and CKD and the clinical effectiveness of febuxostat, a nonpurine selective xanthine oxidase inhibitor. Results from this study could potentially affect current CKD management guidelines, particularly in the Western world, where pharmacotherapy for asymptomatic hyperuricemia is not proactively recommended. We recognize the study limitations, including small size and short follow-up, and are concerned about the generalizability of the results. In addition, the authors do not comment about whether a statistically significant difference exists in baseline characteristics between the groups, notably age, sex, proteinuria, body mass index, dietary factors, and alcohol use. We wonder how much confounding effect these parameters have on the results, considering that they are established independent risk factors for a decline in kidney function. We agree that more studies with larger population size are needed to fully explore not only the clinical benefits of febuxostat, but also adverse effects, such as rhabdomyolysis and elevated liver function test results. We suggest that future trials specifically address the possible confounders mentioned. Furthermore, we propose including serum cystatin C, a more sensitive marker for kidney function, to better appreciate the effects of febuxostat.
Giving voice to patients' and family caregivers' needs in chronic heart failure: implications for palliative care programs.

BACKGROUND The American College of Cardiology Foundation/American Heart Association (ACC/AHA) Guidelines for the Management of Heart Failure recommend palliative care in the context of Stage D HF or at the end of life. Previous studies related to heart failure (HF) palliative care provide useful information about patients' experiences, but they do not provide concrete guidance for what palliative care needs are most important and how a palliative care program should be structured. OBJECTIVES Describe HF patients' and their family caregivers' major concerns and needs. Explore whether, how, and when palliative care would be useful to them. DESIGN AND PARTICIPANTS Qualitative study using in-depth interviews of 33 adult outpatients with symptomatic HF identified using purposive sampling and 20 of their family caregivers. APPROACH Interviews were transcribed verbatim and analyzed using the constant comparative method. KEY RESULTS Overall, patients and caregivers desired early support adjusting to the limitations and future course of illness, relief of a number of diverse symptoms, and the involvement of family caregivers using a team approach. A diverse group of participants desired these elements of palliative care early in illness, concurrent with their disease-specific care, coordinated by a provider who understood their heart condition and knew them well. Some diverging needs and preferences were found based on health status and age. CONCLUSIONS HF patients and their family caregivers supported early integration of palliative care services, particularly psychosocial support and symptom control, using a collaborative team approach. Future research should test the feasibility and effectiveness of integrating such a program into routine HF care.
AJKD Atlas of Renal Pathology: Tubular Atrophy.

Tubular atrophy is a general term that describes several patterns of chronic tubular injurywith thickened tubular basement membranes, and clinically manifests as chronic kidney disease with decreased glomerular filtration rate. Increased extent of tubular atrophy and accompanying interstitial fibrosis correlates with worse prognosis. Proteinuria is variable, depending on cause. Light microscopy: The most common pattern, not otherwise specified, shows thickened and wrinkled tubular basement membranes with flattened, simplified tubular epithelial cells and contraction of the tubular lumen. There is a proportional extent of interstitial fibrosis separating tubular profiles. The endocrinization pattern is characterized by shrunken tubules with cuboidal epithelial cells with narrowed lumen and little to no thickening of tubular basement membranes. Thyroidization of tubules is characterized by enlarged round tubules with markedly flattened epithelium with uniform intratubular casts, resembling thyroid colloid. Immunofluorescence microscopy: No specific staining. Electron microscopy: Thickened, often lamellated tubular basement membranes with simplified tubular epithelial cells.
Nonclinical Core Competencies and Effects of Interprofessional Teamwork in Disaster and Emergency Response Training and Practice: A Pilot Study

Abstract Objective To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration. Methods In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis. Results Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration. Conclusions The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1–8)
Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate: A Prospective, Cross-sectional Study.

BACKGROUND Women and small men treated by hemodialysis (HD) have reduced survival. This may be due to use of total-body water (V) as the normalizing factor for dialysis dosing. In this study, we explored the equivalent dialysis dose that would be delivered using alternative scaling parameters matching the current recommended minimum Kt/V target of 1.2. STUDY DESIGN Prospective cross-sectional study. SETTING & PARTICIPANTS 1,500 HD patients on a thrice-weekly schedule, recruited across 5 different centers. PREDICTORS Age, sex, weight, race/ethnicity, comorbid condition level, and employment status. OUTCOMES Kt was estimated by multiplying V by 1.2. Kt/body surface area (BSA), Kt/resting energy expenditure (REE), Kt/total energy expenditure (TEE) and Kt/normalized protein catabolic rate (nPCR) equivalent to a target Kt/V of 1.2 were then estimated by dividing Kt by the respective parameters. MEASUREMENTS Anthropometry, HD adequacy details, and BSA were obtained by standard procedures. REE was estimated using a novel validated equation. TEE was calculated from physical activity data obtained using the Recent Physical Activity Questionnaire. nPCR was estimated using a standard formula. RESULTS Mean BSA was 1.87m2; mean REE, 1,545kcal/d; mean TEE, 1,841kcal/d; and mean nPCR, 1.03g/kg/d. For Kt/V of 1.2, there was a wide range of equivalent doses expressed as Kt/BSA, Kt/REE, Kt/TEE, and Kt/nPCR. The mean equivalent dose was lower in women for all 4 parameters (P<0.001). Small men would also receive lower doses compared with larger men. Younger patients, those with low comorbidity, those employed, and those of South Asian race/ethnicity would receive significantly lower dialysis doses with current practice. LIMITATIONS Cross-sectional study; physical activity data collected by an activity questionnaire. CONCLUSIONS Current dosing practices may risk underdialysis in women, men of smaller body size, and specific subgroups of patients. Using BSA-, REE-, or TEE-based dialysis prescription would result in higher dose delivery in these patients.
Prevention of Post-Concussional Syndrome in North American Workers: The Importance of Early Intervention on Vocational Outcome

Abstract The purpose of this study was to: (1) Establish whether or not specific rehabilitation for mild brain injury is effective for return to work; and (2) compare the efficacy of an impairment-focused model of treatment versus an early education approach in respect to ability to return to work. Two different approaches to intervention and treatment for those with a suspected concussion from a work-related injury were utilised by an urban, interdisciplinary, outpatient rehabilitation facility. The first approach, Group Treatment (GT), provided minimal early education at time of initial intake, emphasising an extensive group-focused interdisciplinary assessment and treatment. The second approach, Individualized Education and Treatment, (IET) emphasised early education, instead coupled with specific individualised services. Both groups received employment services. Post-discharge, GT (N = 26) resulted in 46% (n = 12) of individuals returning to competitive employment, while IET (N = 23) resulted in 78% (n = 18) of individuals returning to competitive employment. An asset-oriented early individualised educational approach appears to be a more effective for employment re-engagement.
Examining Public Health Workers’ Perceptions Toward Participating in Disaster Recovery After Hurricane Sandy: A Quantitative Assessment

Abstract Objective We aimed to quantitatively gauge local public health workers’ perceptions toward disaster recovery role expectations among jurisdictions in New Jersey and Maryland affected by Hurricane Sandy. Methods An online survey was made available in 2014 to all employees in 8 Maryland and New Jersey local health departments whose jurisdictions had been impacted by Hurricane Sandy in October 2012. The survey included perceptions of their actual disaster recovery involvement across 3 phases: days to weeks, weeks to months, and months to years. The survey also queried about their perceptions about future involvement and future available support. Results Sixty-four percent of the 1047 potential staff responded to the survey (n=669). Across the 3 phases, 72% to 74% of the pre-Hurricane Sandy hires knew their roles in disaster recovery, 73% to 75% indicated confidence in their assigned roles (self-efficacy), and 58% to 63% indicated that their participation made a difference (response efficacy). Of the respondents who did not think it likely that they would be asked to participate in future disaster recovery efforts (n=70), 39% indicated a willingness to participate. Conclusion The marked gaps identified in local public health workers’ awareness of, sense of efficacy toward, and willingness to participate in disaster recovery efforts after Hurricane Sandy represent a significant infrastructural concern of policy and programmatic relevance. (Disaster Med Public Health Preparedness. 2016;10:371–377)
Angular effect of optical fiber movement on endoscopic laser prostatectomy

The optimal fiber manipulation during laser prostatectomy has been highlighted as a critical element to achieve desirable clinical outcomes. However, scientific understanding of the physical interplay between fiber movement and ablative tissue response is still lacking. The objective of this study was to quantitatively investigate the effect of angular movement of an optical fiber on tissue ablation performance.
Hiperplasia gingival por ciclosporina: A propósito de un caso

Gingival enlargement can be an adverse effect of ciclosporine Aand nifedipine use. It has a high relapse rate if the drugs are not discontinued. There is agenetic predisposition to the development of this condition and dental biofilm can also play arole. We report a 64 years old male who received a renal allograft and was treated withcyclosporine and nifedipine. He required six surgical interventions for generalized gingivalenlargement. After the sixth relapse, the patient was subjected to a periodontal treatment toeliminate the dental biofilm, which decreased the rate of recurrence of gingival enlargement(Rev Med Chile 2007; 135: 370-74). (
Medical relief for the 2011 Japan earthquake: a nursing account.

In 2011 the east coast of Japan experienced a massive earthquake which triggered a devastating tsunami destroying many towns and killing over 15 000 people. The work presented in this paper is a personal account that outlines the relief efforts of the Humanitarian Medical Assistance team and describes the efforts to provide medical assistance to evacuees. The towns most affected had a large proportion of older people who were more likely to have chronic conditions and required medication to sustain their health. Since personal property was destroyed in the tsunami many older people were left without medication and also did not remember which type of medication they were taking. Some evacuees had brought a list of their medication with them, this assisted relief teams in obtaining the required medication for these people. The more successful evacuation centers had small numbers of evacuees who were given tasks to administer the center that kept them occupied and active.
Nutritional Components Modify Metal Absorption, Toxic Response and Chelation Therapy

Deficiency of several essential nutrients, namely vitamins and essential elements, has been shown to exacerbate the toxic effects of metals, and supplementation of such nutrients ameliorates the toxicity. It is important to evaluate the present levels of metal exposure and the quantities of dietary nutrient supplements that might either augment or protect against the adverse effects of the metals, so that multifaceted components contributing to safety can be incorporated into regulatory decisions. In addition to the role of micronutrients in modifying metal toxicity, these nutritional components (vitamins, essential metals, etc.) can also act as complementary chelating agents (adjuvants) increasing the efficacy of a known chelator, or by acting independently. This article summarizes the major experimental work carried out on the influence of various nutritional factors on metal toxicity and discusses future research.
The psychiatrist and war

SMALL, R. H. (1984) Practical training in the management of psychiatric combat casualties. Military Medicine, 149, 276-279. SOLOMON, Z. & BENBENISHTY, R. (1986) The role of proxi mity, immediacy and expectancy in front-line treatment of combat stress reaction among Israelis in the Lebanon war. American Journal of Psychiatry, 143, 613-617. SOLOMON, Z. , MIKULINCER, M. , JAKOB,B. R. (1987) Ex posure to recurrent combat stress: combat stress reac tions among Israeli soldiers in the 1982 Lebanon war. Psychological Medicine, 17,433-440. SUTNER,P. B. , BUGG,F. & ALLAIN,A. (1990) Person and situational correlates of post-traumatic stress dis order among POW survivors. Psychological Reports, 66, 912-914. 203
Leveraging the health and retirement study to advance palliative care research.

BACKGROUND The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine's series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject's death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care. SETTING While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas. CONCLUSION In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research.
Effects of PKC412, nilotinib, and imatinib against GIST-associated PDGFRA mutants with differential imatinib sensitivity.

BACKGROUND & AIMS Activating mutations in platelet-derived growth factor receptor alpha (PDGFRA) have been reported in a subset of gastrointestinal stromal tumor (GIST) patients who do not express the mutant stem cell factor receptor c-kit. The responsiveness of mutant PDGFRA-positive GIST to imatinib depends on the location of the PDGFRA mutation; for example, the V561D juxtamembrane domain mutation is more sensitive to imatinib than the D842V kinase domain mutation. In this study, we compare the effects of 3 tyrosine kinase inhibitors, PKC412 and nilotinib, and imatinib, on 2 GIST-related PDGFRA mutants, V561D and D842V, which possess differential sensitivity to imatinib. METHODS The effects of PKC412, nilotinib, and imatinib, alone and in combination, were evaluated via in vitro proliferation studies performed with V561D- or D842V-PDGFRA mutants. The effects of nilotinib and PKC412, alone and combined, were investigated in vivo. RESULTS PKC412 potently inhibited the V561D-PDGFRA mutant in vitro and the D842V-PDGFRA mutant in vitro and in vivo. Both imatinib and nilotinib displayed potent activity in vitro against the V561D-PDGFRA mutant but were significantly less efficacious against D842V-PDGFRA. However, when combined with either imatinib or PKC412, nilotinib showed no evidence for antagonism and acted in a cooperative fashion against D842V-PDGFRA. CONCLUSIONS Our findings support the clinical testing of PKC412 for treatment of mutant PDGFRA-GIST. The data also support the use of nilotinib as a treatment option for V561D-PDGFRA-associated GIST, although the reduced sensitivity of D842V-PDGFRA probably limits the potential of nilotinib monotherapy for D842V-PDGFRA-associated GIST.
Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: A split‐scar, evaluator‐blinded study

Despite precise surgical technique, some postoperative facial scars will depress and widen over time, likely due to weakened or inadequately replaced collagen fibers in the underlying dermis. The purpose of this study is to evaluate whether a 10,600 nm ablative carbon dioxide (CO2) fractional laser used early in the post‐surgical setting results in improved postoperative facial scars after a single treatment session.