Miracle-dz/UniFAR-FTUs huggingface dataset:
RE: Circulating Adipokines and Inflammatory Markers and Postmenopausal Breast Cancer Risk.

Obesity is a risk factor for breast cancer in postmenopausal women. In their recent article, Gunter et al. found that associations between breast cancer risk and circulating levels of adipokines were null to modest. Importantly, they underscored that adipokines primarily function in a paracrine manner. Hence, adipokine plasma levels might be a poor surrogate for breast tissue levels (1). This is reminiscent of the situation observed with vitamin D. Obesity is inversely associated with vitamin D levels (2), and vitamin D inadequacy is observed in postmenopausal women (2). Moreover, 1,25-dihydroxyvitamin D (1,25D), the active metabolite of vitamin D, limits adipose tissue inflammation and suppresses leptin stimulation of cancer growth (3). As for adipokines, studies that have investigated the association between circulating levels of vitamin D and breast cancer risk gave mixed results (4,5). Could vitamin D and adipokines be two faces of the same coin? Vitamin D is barely active and requires two successive hydroxylations to produce 1,25D. The first hydroxylation is catalyzed in the liver by CYP2R1, the second one in the kidney by CYP27B1. This is the vitamin D endocrine system in which 1,25D is released in blood circulation and controls calcium homeostasis and skeletal health. Circulating 25(OH)-vitamin D levels between 50 and 75 nmol/L are considered indicative of vitamin D sufficiency. A paradigm shift recently occurred with the discovery of autocrine/paracrine vitamin D signaling in many tissues. In autocrine/paracrine systems, molecules are produced, act, and are degraded locally. Therefore, the autocrine/paracrine vitamin D signaling does not affect circulating levels of vitamin D metabolites. Two important features of the autocrine/paracrine vitamin D system are: 1) the regulation of CYP2R1 and CYP27B1 expression by inflammatory stimuli (6) and 2) the local storage of vitamin D in fat tissue (6). Hence, hydroxylated metabolites of vitamin D can be produced locally in response to inflammatory stimuli if sufficient local storage of vitamin D exists. Note that vitamin D
Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.

BACKGROUND An up-to-date overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking. OBJECTIVES To assess the effectiveness and safety of short-term (< three months) and long-term (> three months) dynamic exercise therapy programs (aerobic capacity and/or muscle strength training), either land or water-based, for people with RA. To do this we updated a previous Cochrane review (van den Ende 1998) and made categories for the different forms of dynamic exercise programs. SEARCH STRATEGY A literature search (to December 2008) within various databases was performed in order to identify randomised controlled trials (RCTs). SELECTION CRITERIA RCTs that included an exercise program fulfilling the following criteria were selected: a) frequency at least twice weekly for > 20 minutes; b) duration > 6 weeks; c) aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and d) performed under supervision. Moreover, the RCT included one or more of the following outcome measures: functional ability, aerobic capacity, muscle strength, pain, disease activity or radiological damage. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, rated the methodological quality, and extracted data. A qualitative analysis (best-evidence synthesis) was performed and, where appropriate, a quantitative data analysis (pooled effect sizes). MAIN RESULTS In total, eight studies were included in this updated review (two additional studies). Four of the eight studies fulfilled at least 8/10 methodological criteria. In this updated review four different dynamic exercise programs were found: (1) short-term, land-based aerobic capacity training, which results show moderate evidence for a positive effect on aerobic capacity (pooled effect size 0.99 (95% CI 0.29 to 1.68). (2) short-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength (pooled effect size 0.47 (95% CI 0.01 to 0.93). (3) short-term, water-based aerobic capacity training, which results show limited evidence for a positive effect on functional ability and aerobic capacity. (4) long-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength. With respect to safety, no deleterious effects were found in any of the included studies. AUTHORS' CONCLUSIONS Based on the evidence, aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.
Treatment dropout of patients in National Continuing Management and Intervention Program for Psychoses in Guangdong Province from 2006 to 2009: Implication for mental health service reform in China

In 2005, China commenced its mental health reform by establishing a national program to move from a hospital‐based service model to an integrated hospital and community treatment model for psychoses, adopting the key principles of and provisions for continuity of care, treatment accessibility and equitable mental health care. This paper reports the rate and associated factors of treatment dropout for patients with psychoses in the national program in Guangdong Province from 2006 to 2009.
Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children.

BACKGROUND Scoliosis surgery is often associated with substantial blood loss and potential detrimental effects in children. Antifibrinolytic agents are often used to reduce perioperative blood loss. Clinical trials have evaluated their effect in children undergoing surgical correction of scoliosis but no systematic review has been published. We performed a systematic review on the efficacy and safety of antifibrinolytic drugs in children undergoing scoliosis surgery. OBJECTIVES To assess the efficacy and safety of aprotinin, tranexamic acid and aminocaproic acid in reducing blood loss and transfusion requirements in children undergoing scoliosis surgery. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2007, Issue 3), OVID MEDLINE (1950 to September 3rd 2007), LILACS (1992 to June 20th 2007) and EMBASE (1980 to July 23rd 2007). We also searched conference proceedings from 2003 to 2007 and the clinicaltrials.gov registry. No language restriction was applied. SELECTION CRITERIA We included blinded or unblinded randomized controlled trials that evaluated the effect of antifibrinolytics on perioperative blood loss in children that were 18 years of age or younger and undergoing scoliosis surgery. DATA COLLECTION AND ANALYSIS Two authors independently performed the data extraction. Primary outcomes were mortality and number of patients transfused. Secondary outcomes were number of patients transfused with allogeneic blood, amount of total blood transfused, total blood loss and adverse events. To assess heterogeneity we used the I(2) test and for the quantitative analysis we used a fixed-effect model. MAIN RESULTS Six studies fulfilled the inclusion criteria. The total number of participants was 254, of whom 127 were allocated to placebo and 127 to antifibrinolytic drugs. Aprotinin, tranexamic acid and aminocaproic acid were evaluated in two studies each. All studies had placebo as the control group intervention. There were no deaths or any serious adverse events in any study, in either the active or the control group. The risk of being transfused was similar in patients receiving antifibrinolytic drugs or placebo. Antifibrinolytics drugs decreased the amount of blood transfused by 327 ml (95% CI -469.04 to -185.78) and the amount of blood loss by 427 ml (95% CI -602.51 to -250.56). There was no indication of publication bias, however, we cannot rule it out due to the small number of studies included. AUTHORS' CONCLUSIONS The effect of antifibrinolytic drugs on mortality could not be assessed. Antifibrinolytic drugs reduced blood loss and the amount of blood transfused in children undergoing scoliosis surgery; however, their effect on the number of children requiring blood transfusion remains unclear. Aprotinin, tranexamic acid and aminocaproic acid seem to be similarly effective.
Elevated Bladder Cancer in Northern New England: The Role of Drinking Water and Arsenic.

BACKGROUND Bladder cancer mortality rates have been elevated in northern New England for at least five decades. Incidence rates in Maine, New Hampshire, and Vermont are about 20% higher than the United States overall. We explored reasons for this excess, focusing on arsenic in drinking water from private wells, which are particularly prevalent in the region. METHODS In a population-based case-control study in these three states, 1213 bladder cancer case patients and 1418 control subjects provided information on suspected risk factors. Log transformed arsenic concentrations were estimated by linear regression based on measurements in water samples from current and past homes. All statistical tests were two-sided. RESULTS Bladder cancer risk increased with increasing water intake (Ptrend = .003). This trend was statistically significant among participants with a history of private well use (Ptrend = .01). Among private well users, this trend was apparent if well water was derived exclusively from shallow dug wells (which are vulnerable to contamination from manmade sources, Ptrend = .002) but not if well water was supplied only by deeper drilled wells (Ptrend = .48). If dug wells were used pre-1960, when arsenical pesticides were widely used in the region, heavier water consumers (>2.2 L/day) had double the risk of light users (<1.1 L/day, Ptrend = .01). Among all participants, cumulative arsenic exposure from all water sources, lagged 40 years, yielded a positive risk gradient (Ptrend = .004); among the highest-exposed participants (97.5th percentile), risk was twice that of the lowest-exposure quartile (odds ratio = 2.24, 95% confidence interval = 1.29 to 3.89). CONCLUSIONS Our findings support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in New England. In addition, historical consumption of water from private wells, particularly dug wells in an era when arsenical pesticides were widely used, was associated with increased bladder cancer risk and may have contributed to the New England excess.
Psychological interventions for treatment of inflammatory bowel disease.

BACKGROUND The effect of psychological interventions in inflammatory bowel diseases (IBD) is controversial. OBJECTIVES To assess the effects of psychological interventions (psychotherapy, patient education, relaxation techniques) on health related quality of life, coping, emotional state and disease activity in IBD. SEARCH STRATEGY We searched the specialized register of the IBD/FBD Group, CENTRAL (Issue 5, 2010) and from inception to April 2010: Medline, Embase, LILACS, Psyndex, CINAHL, PsyInfo, CCMed, SOMED and Social SciSearch. Conference abstracts and reference lists were also checked. SELECTION CRITERIA Randomized, quasi-randomized and non randomized controlled trials of psychological interventions in children or adults with IBD with a minimum follow up time of 2 months. DATA COLLECTION AND ANALYSIS Data were extracted and study quality was independently assessed by two raters. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model. MAIN RESULTS Twenty-one studies were eligible for inclusion (1745 participants, 8 RCT, 4 QRCT, 8 NRCT; 19 in adults, 2 in adolescents). Most studies used multimodular approaches. The risk of bias was high for all studies.In adults, psychotherapy had no effect on quality of life at around 12 months (3 studies, 235 patients, SMD -0.07; 95% CI -0.33 to 0.19), emotional status (depression, 4 studies, 266 patients, SMD 0.03; 95% CI -0.22 to 0.27) or proportion of patients not in remission (5 studies, 287 patients, OR 0.85; 95% CI 0.48 to 1.48). Results were similar at 3 to 8 months. There was no evidence for statistical heterogeneity or subgroup effects based on type of disease or intensity of the therapy. In adolescents, there were positive short term effects of psychotherapy on most outcomes assessed including quality of life (2 studies, 71 patients, SMD 0.70; 95% CI 0.21 to 1.18) and depression (1 study, 41 patients, SMD -0.62; 95% CI -1.25 to 0.01). Educational interventions were ineffective with respect to quality of life at 12 months (5 studies, 947 patients, SMD 0.11; 95% CI -0.02 to 0.24), depression (3 studies, 378 patients, SMD -0.08; 95% CI -0.29 to 0.12) and proportion of patients not in remission (3 studies, 434 patients, OR 1.00; 95% CI 0.65 to 1.53). AUTHORS' CONCLUSIONS There is no evidence for efficacy of psychological therapy in adult patients with IBD in general. In adolescents, psychological interventions may be beneficial, but the evidence is limited. Further evidence is needed to assess the efficacy of these therapies in subgroups identified as being in need of psychological interventions, and to identify what type of therapy maybe most useful.
Surgical resection versus liver transplant for patients with hepatocellular carcinoma.

BACKGROUND Hepatocellular carcinoma is a major worldwide health problem, involving more than half a million new patients yearly, with a different incidence in different parts of the world. Hepatocellular carcinoma develops in about 80% of cirrhotic patients, and cirrhosis is considered the strongest predisposing factor for it. Surgical resection and liver transplantation are conventional treatment modalities that can offer long-term survival for patients with hepatocellular carcinoma. OBJECTIVES To assess the benefits and harms of surgical resection compared with those of liver transplantation in patients with hepatocellular carcinoma. SEARCH METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (SCI-EXPANDED) at ISI Web of Science (last search February 2013). We also searched the abstracts from annual meetings of the American Society of Clinical Oncology, the American Association for the Study of Liver Diseases (AASLD), and the European Association for the Study of the Liver (EASL), provided through The Cochrane Hepato-Biliary Group until February 2013. SELECTION CRITERIA Randomised clinical trials comparing surgical resection and hepatic transplantation. DATA COLLECTION AND ANALYSIS The search strategies were run and two authors individually evaluated whether the retrieved studies fulfilled the inclusion criteria. MAIN RESULTS No randomised clinical trials comparing surgical resection and liver transplantation as the major methods of treating hepatocellular carcinoma were found. AUTHORS' CONCLUSIONS There are no randomised clinical trials comparing surgical resection and liver transplantation for hepatocellular carcinoma treatment.
Understanding Implementation: a sociotechnical appraisal of the introduction of computerized physician order entry systems in Dutch and American hospitals

textabstract"Developing a comprehensive medical information system was a more complex task than putting a man on the moon had been", wrote the eminent medical informatics scholar Morris Collen in 1995. This thesis describes and analyzes the implementation of computerized order entry systems in Dutch and American hospitals. The case studies show how difficult it is to get such systems to work in clinical practice. How such systems can be implemented requires a thorough understanding of medical work practices. The author concludes that formal implementation procedures have limited value and that the successful implementation requires time and a great deal of improvisation. This will allow the prospective user to get acquainted with the system and improve her clinical practice through the opportunities provided by the system. In short, implementing a clinical information system is a thoroughly social process.
Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief.

BACKGROUND Caesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation. Local anaesthetics, either on their own or in combination with opioids or nonsteroidal antiinflammatory drugs, have been employed as an adjunct to other postoperative pain relief strategies. Conflicting reports were noted. OBJECTIVES To assess the effects of local anaesthetic agent wound infiltration/irrIgation and/or abdominal nerve blocks on post-caesarean section pain and the mother's well being and interaction with her baby. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009). SELECTION CRITERIA Randomised controlled trials of pre-emptive local analgesia during caesarean section. DATA COLLECTION AND ANALYSIS One author extracted data. The second author checked the data. MAIN RESULTS Twenty studies (1150 women) were included. Women who had caesarean section performed under regional analgesia and had wound infiltration had a decrease in morphine consumption at 24 hours (SMD -1.70mg; 95% confidence interval (CI) -2.75 to -0.94) compared to placebo.In women under general anaesthesia, with caesarean section wound infiltration and peritoneal spraying with local anaesthetic (one study, 100 participants), the need for opioid rescue was reduced (risk ratio (RR) 0.51; 95% CI 0.38 to 0.69). The numerical pain score (0 to10) within the first hour was also reduced (mean difference (MD) -1.46; 95% CI -2.60 to -0.32). Women with regional analgesia who had local anaesthetic and non-steriodal anti-inflammatory cocktail wound infiltration consumed less morphine (one study, 60 participants; MD -7.40 mg; 95% CI -9.58 to -5.22) compared to local anaesthetic control.Women who had regional analgesia with abdominal nerves blocked had decreased opioid consumption (four studies, 175 participants; MD -25.80 mg; 95% CI -50.39 to -5.37). For the outcome of visual analogue scale 0 to 10 over 24 hours, no advantage was demonstrated in the single study of 50 participants who had wound infiltrated with a mixture of local analgesia and narcotics versus local analgesia.Addition of ketamine to the local analgesia in women who had regional analgesia does not confer any advantage. AUTHORS' CONCLUSIONS Local analgesia infiltration and abdominal nerve blocks as adjuncts to regional analgesia and general anaesthesia are of benefit in caesarean section by reducing opioid consumption. Nonsteroidal anti-inflammatory drugs as an adjuvant may confer additional pain relief.
An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector: Findings and therapeutic implications

Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9%‐96.7%). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia.
Antivirals for idiopathic sudden sensorineural hearing loss.

BACKGROUND Idiopathic sudden sensorineural hearing loss (ISSHL) is characterised by sudden loss of hearing of cochlear or retro-cochlear origin without an identifiable cause. Antivirals are commonly prescribed, but there is no consensus on the treatment regimen or their effectiveness. OBJECTIVES To determine the effectiveness and side effect profile of antivirals in the treatment of ISSHL. SEARCH METHODS We systematically searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), PubMed, EMBASE, CINAHL and other databases to 12 June 2012. We also scanned the reference lists of identified studies for further trials. SELECTION CRITERIA Randomised controlled trials comparing different antivirals versus placebo (both with or without other treatment). DATA COLLECTION AND ANALYSIS Two authors independently extracted data, met to resolve disagreements and contacted study authors for further information. We assessed study risk of bias independently. We considered meta-analysis inappropriate and ultimately not possible due to differing treatment protocols of varying dose and duration, together with differing inclusion criteria and outcome measures between studies. The results of each study are reported individually. MAIN RESULTS We included four randomised trials (257 participants). The overall risk of bias in the included studies was low. Two trials compared the addition of intravenous acyclovir to a steroid (prednisolone). One included 43 participants, the other 70 patients. Neither demonstrated any hearing improvement with ISSHL. Another (84 patients) did not show any statistically significant difference between groups with the addition of valacyclovir to prednisolone (compared to steroid plus placebo) with respect to change in pure-tone audiogram. Comparing the addition of intravenous acyclovir to hydrocortisone with hydrocortisone alone, the final trial did not show any statistically significant difference between groups (60 patients). No trial documented any serious adverse effects related to the use of antiviral treatment. One study reported slight to moderate nausea equally in the acyclovir and placebo groups (one patient in each). Another reported insomnia, nervousness and weight gain with valacyclovir (number not specified). Even though no meta-analysis was possible, evidence from the four RCTs has demonstrated no statistically significant advantage in the use of antivirals in the treatment of ISSHL. AUTHORS' CONCLUSIONS There is currently no evidence to support the use of antiviral drugs in the treatment of ISSHL. The four trials included in this review were, however, small and with a low risk of bias. Further randomised controlled trials with larger patient populations, using standardised inclusion criteria, antiviral regimes and outcome measures, are needed in order for adequate meta-analysis to be performed to reach definitive conclusions. A uniform definition of ISSHL should also be established, together with what constitutes adequate recovery.