Miracle-dz/UniFAR-FTUs huggingface dataset:
A Case of Ovarian Metastasis from Microinvasive Adenosquamous Carcinoma of the Uterine Cervix

Background: Ovarian metastasis is rare in cases of early-stage uterine cervical cancer. For the patients with stage 1b cervical cancer, the incidences of ovarian metastasis were 0.22% of squamous cell carcinoma and 3.72% of adenocarcinoma. The safety of ovarian preservation is controversial for young women, although these women may find it important to preserve fertility. Case: A 36-year-old Japanese woman underwent a loop electrosurgical excision procedure for cervical adenosquamous carcinoma with invasion of 0.8 mm in depth and 1 mm in horizontal extent. She wished to preserve her fertility and was therefore followed up without additional treatments. Thirty months after the loop electrosurgical excision procedure, she had 10 cm-diameter ovarian tumors and underwent hysterectomy, bilateral salpingooophorectomy, appendectomy. This ovarian tumor was revealed to metastasis from cervical carcinoma. Conclusion: To our knowledge, this is first reported case of ovarian metastasis with microinvasive adenosquamous cell carcinoma. The pathological characteristics are important for prognosis: frequent small foci of invasion and high atypia.
Identifying outpatients with renal insufficiency before contrast-enhanced CT by using estimated glomerular filtration rates versus serum creatinine levels.

PURPOSE To determine whether using estimated glomerular filtration rate (eGFR) values rather than serum creatinine levels to identify patients with renal insufficiency facilitates any substantial change in the number of outpatients scheduled for computed tomography (CT) who are considered at increased risk for contrast medium-induced nephropathy. MATERIALS AND METHODS The study was HIPAA compliant and institutional review board approved for medical chart review; the requirement for informed patient consent was waived. Patients (n = 5138; 2569 women, 2569 men, 753 African Americans, 4385 non-African Americans) examined during a 2-year period formed the final study group after exclusion of patients undergoing dialysis (n = 49), for whom no age data were recorded (n = 9), and younger than 18 years (n = 113). Patient age, sex, and race and the blood urea nitrogen, albumin, and serum creatinine levels most recently measured within 6 months before CT were obtained from the electronic medical records. The number of patients with creatinine levels higher than 1.4 mg/dL was directly compared with the number of patients with eGFR values (calculated with four- and six-variable Modification of Diet in Renal Disease [MDRD] equations) lower than 60 mL/min/1.73 m(2) by using the two-tailed McNemar test. For 2689 patients, data to calculate the eGFR by using the four-variable equation were available, and for 2005 patients, data to calculate the eGFR by using the six-variable equation were available. RESULTS Among the outpatients scheduled to undergo CT, the percentage of patients with an eGFR lower than 60 mL/min/1.73 m(2) was significantly greater than the percentage of patients with a creatinine level higher than 1.4 mg/dL for both the four-variable (412 [15.3%] vs 166 [6.2%] of 2689 patients) and the six-variable (346 [17.3%] vs 117 [5.8%] of 2005 patients) MDRD equation groups (P < .001). CONCLUSION A significantly higher number of outpatients scheduled for contrast medium-enhanced CT met the National Kidney Foundation criteria for renal insufficiency when the MDRD equations were used to estimate the glomerular filtration rate compared with the number of outpatients who met the criteria on the basis of elevated creatinine levels.
Unpacking the policy landscape for menstrual hygiene management: implications for school WASH programmes in India

Menstrual hygiene management (MHM) relates to how girls and women manage their monthly period, and require access to information about menstruation, clean and safe menstrual absorbents, and amenities and facilities such as toilets and water, and waste management to maintain hygiene. In general MHM is poor in India, with low levels of knowledge and many misconceptions, varied use of menstrual absorbents, and unhygienic practices among adolescent girls. With almost 50 per cent of school age girls enrolled in schools, creating a conducive environment in schools to promote MHM is imperative. This policy scoping exercise examines how select policy initiatives implemented by the Government of India address MHM, especially in the context of schools. This document review found that adolescent girls are a focus of most policy initiatives addressing MHM, with a focus primarily on the hardware (i.e. infrastructure, sanitary napkins) or software (i.e. health education) components. Most programmes are implemented at t.
Tiotropium for stable chronic obstructive pulmonary disease

BACKGROUND Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease (COPD) that differs from ipratropium by its functional relative selectivity for muscarinic receptor subtypes and which allows once-per-day dosing. OBJECTIVES To determine the efficacy of tiotropium on clinical endpoints such exacerbations and hospitalisations, symptom scales and pulmonary function compared to placebo and other bronchodilators used for stable COPD. SEARCH STRATEGY Randomised controlled trials (RCTs) were identified from the Cochrane Airways Review Group Specialised Register, a compilation of systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, and hand searching of 20 respiratory journals. Bibliographies from included studies and reviews were searched. The date of the last search was October 2004. SELECTION CRITERIA Randomised clinical trials comparing tiotropium with placebo, ipratropium bromide, or long-acting ss2-agonists for greater than, or equal to, one month's duration. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data. Missing data were obtained from authors or the manufacturer of tiotropium. The data were analysed using the Cochrane Review Manager RevMan 4.2. Studies were pooled to yield weighted mean differences (WMD) or odds ratios (OR) and reported using 95% confidence intervals (CI). MAIN RESULTS From 69 identified references, nine RCTs (6,584 patients) met inclusion criteria. Tiotropium reduced the odds of a COPD exacerbation (OR 0.74; 95% CI 0.66 to 0.83) and related hospitalisations (OR 0.64; 95% CI 0.51 to 0.82) compared to placebo or ipratropium. When applied to an annual baseline risk of 45% for exacerbations and 10% for hospitalisation, the number of patients needed to treat with tiotropium for one year were 14 (95% CI 11 to 22) to prevent one exacerbation and 30 (95% CI 22 to 61) to prevent one hospitalisation compared to placebo and ipratropium. Reductions in these endpoints compared to long-acting ss2-agonists were not statistically significant. Similar patterns were evident for quality-of-life and symptom scales. Increases in FEV1 and FVC from baseline were significantly larger with tiotropium than with placebo, ipratropium and long-acting ss2-agonists over 6 to 12 months. The decline in trough FEV1 from steady state was 30 ml (95% CI 7 to 53 ml) less with tiotropium than with placebo or ipratropium over one year; no data on decline in FEV1 from steady state were available for long-acting ss2-agonists. Dry mouth was increased by tiotropium. AUTHORS' CONCLUSIONS Tiotropium reduced COPD exacerbations and related hospitalisations compared to placebo and ipratropium. It also improved health-related quality-of-life and symptom scores among patients with moderate and severe disease, and may have slowed decline in FEV1. Additional long-term studies are required to evaluate its effect on mortality and change in FEV1 to clarify its role in comparison to, or in combination with, long-acting ss2-agonists and to assess its effectiveness in mild and very severe COPD.
The Metabolic Syndrome: Some Second Thoughts?

T he clustering of several cardiovascular disease (CVD) risk factors (i.e., hypertension, dyslipidemia, and type 2 diabetes) and the association of such clustering with insulin resistance led investigators to propose the existence of a distinct entity called “the metabolic syndrome,”1 which has been defined by reputable organizations2,3 and assigned its own code (277.7) in the World Health Organization's ICD-9. Thus, the term metabolic syndrome is now institutionalized and part of the medical vocabulary. How useful are the existing definitions of the metabolic syndrome for predicting CVD risk? Is there a common underlying pathophysiological process that can explain the syndrome? Does treatment of the metabolic syndrome differ from the treatment of its individual components? Simply put, does a metabolic syndrome exist distinct from its …
Concurrent Electroencephalography Recording During Transcranial Alternating Current Stimulation (tACS)

Oscillatory brain activities are considered to reflect the basis of rhythmic changes in transmission efficacy across brain networks and are assumed to integrate cognitive neural processes. Transcranial alternating current stimulation (tACS) holds the promise to elucidate the causal link between specific frequencies of oscillatory brain activity and cognitive processes. Simultaneous electroencephalography (EEG) recording during tACS would offer an opportunity to directly explore immediate neurophysiological effects of tACS. However, it is not trivial to measure EEG signals during tACS, as tACS creates a huge artifact in EEG data. Here we explain how to set up concurrent tACS-EEG experiments. Two necessary considerations for successful EEG recording while applying tACS are highlighted. First, bridging of the tACS and EEG electrodes via leaking EEG gel immediately saturates the EEG amplifier. To avoid bridging via gel, the viscosity of the EEG gel is the most important parameter. The EEG gel must be viscous to avoid bridging, but at the same time sufficiently fluid to create contact between the tACS electrode and the scalp. Second, due to the large amplitude of the tACS artifact, it is important to consider using an EEG system with a high resolution analog-to-digital (A/D) converter. In particular, the magnitude of the tACS artifact can exceed 100 mV at the vicinity of a stimulation electrode when 1 mA tACS is applied. The resolution of the A/D converter is of importance to measure good quality EEG data from the vicinity of the stimulation site. By following these guidelines for the procedures and technical considerations, successful concurrent EEG recording during tACS will be realized.
Primary Tuberculous Abscess of the Parotid Gland: A Case Report

Chronic parotiditis is a rare disease of the parotid glands. Both infectious (e.g. tuberculosis) and non-infectious causes (e.g. sarcoidosis, autoimmune diseases, malignancy and duct stones) have been enumerated for this condition. Primary tuberculous parotiditis is a rare disease. It was diagnosed in a 20-year-old soldier after obtaining a biopsy and observing granuloma and caseous necrosis compatible with TB in histological examination of the specimen. Cultures of discharge and tissue were negative in regard to mycobacterium tuberculosis. Also, malignancy was ruled out by histopathological examinations. Therefore, the four drug anti-TB regimen was initiated. The patient was completely treated and there was no report of recurrence. The endemic condition of TB in developing countries such as Iran has increased the rate of extra-pulmonary TB. One of the extra pulmonary sites which is rarely involved in TB is parotid gland; presenting usually as chronic swelling or mass. Therefore, it is recommended to consider TB in the differential diagnosis of parotiditis and chronic swelling of this salivary gland especially in developing countries. (Tanaffos 2006; 5(1): 65-68)
Exploring nurses’ views on effective leadership in Iraq:developing a framework for professional nursing leadership education

The healthcare services in Iraq currently face many challenges. The most noted is the lack of effective nursing leaders to meet the growing needs of the healthcare services. Effective nursing leadership is critical to the healthcare system, affecting work performance, quality of care and staff satisfaction. The literature suggests that nursing leaders in Iraq are not adequately trained to provide leadership to improve the nursing profession and have limited involvement in decision-making. The main aim of this study is to explore the views of nurses on what they believe constitutes effective leadership in Iraq. These views are used to inform the development of an effective framework for nursing leadership education. A mixed methods approach is employed involving a qualitative Phase (20 semi-structured interviews of senior nurses) followed by a quantitative Phase (survey to 210 ward nurses). The sample of nurses came from two large general hospitals in Iraq. The study results indicated that effective nurse leaders need to have a set of characteristics and high personal qualities. Moreover, the results indicated that there were factors that influence the performance, effective leadership behaviour, and professional learning of nurse leader. Test results show that there were significant differences in views of the nurses toward effective leadership behaviour and professional learning of the nurse leader when level of education, gender, and work experience were considered. The qualitative data was thematically analysed and used to develop questions for the survey. Descriptive statistics were used to analyse and interpret the quantitative data. This research concludes that there are three considerations that need to be taken into account for effective nursing leadership. First, key characteristics and a set of essential personal qualities are required for an effective nurse leader. Second, nurse leader performance is affected by professional development and the recognition of nursing as a well-respected profession. Third, personal and motivational behaviours of nurse leaders influence other nurses to become leaders'. The findings from this study have particular significance for the Iraqi context. Lack of previous research and knowledge of nursing leadership education in Iraq makes this study significant as it provides empirical evidence regarding effective leadership styles suggests new strategies to improve healthcare policy and provides a framework for professional nursing leadership education.
Treatment of Blood Clots

This Cardiology Patient Page will focus on medical treatment of blood clots that can cause critical illness by blocking the blood supply to the heart, brain, lungs, or legs. Blood clots that develop in the arteries can cause heart attack, stroke, and severe leg pain and difficulty walking. Blood clots in the veins or venous system can cause deep venous thrombosis (DVT) in the pelvic, leg, and upper extremity veins. When these DVTs break off and travel through the bloodstream to the heart and then to the lung blood vessels, they cause acute pulmonary embolism (PE). 1 Treatment of arterial clots may include aspirin and clopidogrel (oral antiplatelet agents), intravenous antiplatelet agents, heparin (a blood thinner and anticoagulant), and clot busters (thrombolytic agents). In addition to medications, special interventional catheters may be used to remove or compress these arterial clots. ### Antiplatelet Agents Chewing an adult-strength aspirin tablet (325 mg) at the onset of heart attack symptoms can improve survival by 20%. 2 Consequently, healthcare professional personnel administer aspirin to patients who may be experiencing a heart attack, thereby avoiding further injury to the heart muscle before the arrival of emergency medical services.3 The Clopidogrel in Unstable angina to prevent REcurrent events (CURE) Trial showed that clopidogrel, another oral antiplatelet agent, given in conjunction with aspirin, reduces the risk of death even further in the setting of certain types of heart attacks.4 Intravenous antiplatelet agents may also be used to treat impending or evolving heart attacks in combination with aspirin and clopidogrel. This triple antiplatelet therapy is highly potent and predisposes the patient to bruising. However, major bleeding complications, such as stomach ulcer …
Development of the Pediatric Quality of Life Inventory™ (PedsQL™) Food Allergy Module: An examination of child food sensitivity and health-related quality of life

ii List of Tables v Introduction 1 Health Related Quality of Life 1 Health Related Quality of Life: Measures 2 The Pediatric Quality of Life Inventory 6 Pediatric Food Allergy: Prevalence & Statistics 8 Pediatric Food Allergy: Disease Facts 9 Pediatric Food Allergy: Family Functioning 10 Pediatric Food Allergy: Psychological Functioning 11 Pediatric Food Allergy: School Functioning 11 Existing Food Allergy-Specific Quality of Life Measures 12 Rationale for the Current Study 15 Goals of the Current Study 15 Method 16 Measures 19 Results 20 Discussion 26 References 33 Appendix A 49 Appendix B 51 Appendix C 53 Appendix D 55 Appendix E 57 Appendix F 58 Appendix G 60 Appendix H 62
Disease activity, function and costs in early rheumatoid arthritis

Objective. To calculate direct and indirect costs and to studydisease activity and functional ability over 3 yr in early rheumatoidarthritis (RA). Methods. Three hundred and three patients with early (≤1 yr)RA were recruited during a period of 27 months (1996–1998). Data were recorded during 3 yr to assess disease activity, functionalability, medication, health-care utilization and days lost fromwork.Results. Within 3 months, improvements were seen regarding allrecorded variables assessing disease activity and functionalability, but 15% had sustained high or moderate disease activitythroughout the study period. Indirect costs exceeded directcosts in all 3 yr. The average direct costs were € 3704 (US$3297) in year 1 and € 2652 (US$ 2360) in year 3. All costs decreased,except those for medication and surgery. Compared with men,women had more ambulatory care visits and used more complementarymedicine. The indirect costs were € 8871 (US$ 7895) in year 1and remained essentially unchanged; this was similar for bothsexes. Almost 50% were on sick leave or early retirement atinclusion. Sick leave decreased but was offset by an increasein early retirement. The 14 patients who eventually receivedTNF inhibitors incurred higher costs even before prescriptionof anti-TNF therapy.Conclusion. Disease activity and functional ability improvedwithin 3 months after diagnosis of early RA. Direct costs decreased,except for medication and surgery. Indirect costs remained unchanged.Fifteen per cent of the patients had high or moderate diseaseactivity in all 3 yr, indicating a need for more aggressiveearly anti-rheumatic therapy.
The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time.

Several papers have been published in previous years regarding cross-linking and the effect of the procedure on corneal ectasia. Different protocols of cross-linking have been described with or without corneal epithelium removal, with different kinds of riboflavin solution (e.g., hypo-, iso—hyper-osmolar), different impregnation times, and different lengths of UV-A illumination and irradiation power. The huge amount of information could disorient the general ophthalmologist, who has to choose the proper procedure and, moreover, decide the best protocol to treat the patient. The study by Wernli et al. 1 shows in a large number of cases, the biomechanical strengthening effect of cross-linking with various irradiances ranging from 3 to 90 mw/cm2 with illumination times from 30 minutes to 1 minute, respectively. These results show that for irradiances larger than 45 mW/cm2, corresponding to an illumination time of about 2 minutes, there is no significant increase in corneal strengthening. Considering the different tools commercially available and the various ranges of UV-A irradiances, the ophthalmologists, who are not accustomed with cross-linking procedure, could find the approach to cross-linking difficult and confusing; they could erroneously think that a faster procedure would be effective enough and without any side effect, like the original Seiler’s protocol. This paper is crucial because it gives precise information regarding the effective strengthening of the cornea at various irradiances. As the authors suggested, other papers will be needed to validate these results in vivo, study the possible side effects of higher doses of UV light at lower exposure times and consider the flattening effect of the different protocols. The flattening effect of crosslinking over the corneal stroma tended to regularize the corneal shape and allow variation in refraction with increase in best spectacle-corrected visual acuity in several patients. It was not necessarily related to the increase of the biomechanical strengthening of the cornea.
N-Acetylcysteine-Mediated Antioxidation Prevents Hyperglycemia-Induced Apoptosis and Collagen Synthesis in Rat Mesangial Cells

Background/Aims: High-glucose (HG)-induced mesangial apoptosis and fibrogenesis possibly involves reactive oxygen species (ROS) formation and activated mitochondrial stress. We investigated the therapeutic effect of the antioxidant N-acetylcysteine (NAC) on cellular apoptosis and matrix accumulation in HG-treated rat mesangial cells (RMCs). Methods: RMCs were cultured in media containing 5 (control) or 35 mM (HG) glucose. Cellular apoptosis was assayed by TdT-mediated dUTP nick-end labeling staining. Collagen and transforming growth factor-1 gene expression were measured by reverse transcriptase-polymerase chain reaction or Northern blotting. Mitochondrial capacity and intracellular ROS generation was assayed by fluorescence microscopy and flow cytometry, respectively. Cellular ATP production and malondialdehyde (MDA) formation were determined by a luciferin-luciferase reaction and high-performance liquid chromatography, respectively. Cytochrome c release, caspase activation and poly(ADP)ribose polymerase cleavage were assayed by Western blotting. Results: HG-treated RMCs displayed enhanced cellular apoptosis (65%) and collagen gene expression (1.8-fold increase); these reactions could be significantly suppressed by 1 mM NAC (p < 0.05). Intracellular ROS generation, production of ATP and MDA, and caspase-3, -8 and -9 activities were significantly increased in HG-treated RMCs, and were effectively attenuated by addition of NAC. Conclusion: It is concluded that NAC prevents HG-induced mesangial apoptosis and fibrogenesis pathways by the reduction of oxidative stress.
Role of SPECT/CT, Versus Traditional Practices, in Individualizing Treatment of Thyroid Carcinoma

1. Weber DA, Makler PT Jr, Watson EE, Coffey JL, Thomas SR, London J. Radiation absorbed dose from technetium-99m-labeled bone imaging agents. Task Group of the Medical Internal Radiation Dose Committee, The Society of Nuclear Medicine. J Nucl Med. 1989;30:1117–1122. 2. Kurdziel KA, Shih JH, Apolo AB, et al. The kinetics and reproducibility of 18F-sodium fluoride for oncology using current PET camera technology. J Nucl Med. 2012;53:1175–1184.
Breastfeeding and Allergy: The Evidence

Whether breastfeeding protects against the development of allergic disease has been a frequent subject of study and debate for 75 years. This paper summarizes the published evidence concerning the risks of atopic dermatitis, asthma, allergic rhinitis, positive allergen skin tests, and food allergy associated with infant feeding. The summary is based largely on systematic reviews and meta-analyses carried out by other authors. In addition, I also incorporate the evidence from our long-term follow-up of Belarusian children participating in a cluster-randomized trial of a breastfeeding promotion intervention.