Miracle-dz/UniFAR-FTUs huggingface dataset:
TN categorization for rectal and colon cancers based on national survival outcome data

4020 Background: The 6th edition (ed) of AJCC staging subdivided Stage II into IIA(T3N0)/IIB(T4N0) and Stage III into IIIA(T1–2N1M0), IIIB(T3–4N1M0), IIIC(anyTN2M0). Subsequent analyses supported further substaging of Stage III due to improved survival with T1–2N2 cancers. Before making such changes in the AJCC 7th ed, the HTF sought validation in a population-based dataset that depth of invasion interacts with nodal status to affect survival. Methods: SEER population-based data from Jan 1, 1992 to Dec 2004 for 35,829 rectal and 109,953 colon cancer pts was compared to Cooperative Group rectal data on 2551 pts (Rectal Pooled Analysis). Tumors were stratified by SEER’s ‘extent of disease’ and ‘number of positive nodes’ coding schemes. T4N0 cancers were stratified by ‘tumors that perforate visceral peritoneum’ vs ‘tumors that invade or are adherent to adjacent organs or structures’. N1 and N2 were stratified by number of N+: N1(1 vs 2–3), N2(4–6 vs >7). Observed 5-y survival (∼ overall survival, OS) was obt.
Genetic variants associated with cardiac structure and function: a meta-analysis and replication of genome-wide association data.

CONTEXT Echocardiographic measures of left ventricular (LV) structure and function are heritable phenotypes of cardiovascular disease. OBJECTIVE To identify common genetic variants associated with cardiac structure and function by conducting a meta-analysis of genome-wide association data in 5 population-based cohort studies (stage 1) with replication (stage 2) in 2 other community-based samples. DESIGN, SETTING, AND PARTICIPANTS Within each of 5 community-based cohorts comprising the EchoGen consortium (stage 1; n = 12 612 individuals of European ancestry; 55% women, aged 26-95 years; examinations between 1978-2008), we estimated the association between approximately 2.5 million single-nucleotide polymorphisms (SNPs; imputed to the HapMap CEU panel) and echocardiographic traits. In stage 2, SNPs significantly associated with traits in stage 1 were tested for association in 2 other cohorts (n = 4094 people of European ancestry). Using a prespecified P value threshold of 5 x 10(-7) to indicate genome-wide significance, we performed an inverse variance-weighted fixed-effects meta-analysis of genome-wide association data from each cohort. MAIN OUTCOME MEASURES Echocardiographic traits: LV mass, internal dimensions, wall thickness, systolic dysfunction, aortic root, and left atrial size. RESULTS In stage 1, 16 genetic loci were associated with 5 echocardiographic traits: 1 each with LV internal dimensions and systolic dysfunction, 3 each with LV mass and wall thickness, and 8 with aortic root size. In stage 2, 5 loci replicated (6q22 locus associated with LV diastolic dimensions, explaining <1% of trait variance; 5q23, 12p12, 12q14, and 17p13 associated with aortic root size, explaining 1%-3% of trait variance). CONCLUSIONS We identified 5 genetic loci harboring common variants that were associated with variation in LV diastolic dimensions and aortic root size, but such findings explained a very small proportion of variance. Further studies are required to replicate these findings, identify the causal variants at or near these loci, characterize their functional significance, and determine whether they are related to overt cardiovascular disease.
Antiretroviral Treatment of Adult HIV Infection2010 Recommendations of the International AIDS Society–USA Panel

SUCCESSFUL ANTIRETROVIRAL therapy (ART) is associated with dramatic decreases in AIDSdefining conditions and their associated mortality. Expansion of treatment options and evolving knowledge require revision of guidelines for the initiation and long-term management of ART in adults with HIV infection. Since the 2008 International AIDS Society–USA ART guidelines, new data have emerged regarding timing of therapy, optimal regimen choices, and monitoring. There are also issues of special relevance to circumstances such as pregnancy, hepatitis virus coinfections, kidney disease, cardiovascular disease, and primary HIV infection. Analyses of clinical trials and epidemiologic cohorts have shed light on the role of ART in mitigating serious nonAIDS events associated with uncontrolled HIV replication. Newer drugs are better understood in terms of efficacy, toxicity, and potential uses. New data also suggest a role for ART in the prevention of HIV transmission.
Reframing HIV prevention in sub-Saharan Africa using couple-centered approaches.

This article focuses on couple-centered approaches in the prevention of HIV in sub-Saharan Africa. First it describes the barriers to couples-centered HIV prevention which are social systemic programmatic and historical. Most HIV prevention care and treatment programs have focused on individuals rather than couples making disclosure and partner testing a challenge. Second it discusses opportunities for overcoming the barriers associated with couple-centered approaches which include: addressing gender-imbalanced power dynamics home-based HIV testing and counseling guidelines and delivery of comprehensive maternal and child health services.
Substance misuse and dependence: older people deserve better services

It is not easy to establish with any confidence the prevalence of drug misuse in older people. The issue is confounded by variations in definition of what constitutes ‘elderly’ and ‘drug misuse’, and by the types of sample used (Tables 1 and 2). There are few large-scale studies in the UK, and much of the information has been extrapolated from the American findings. The available information can be organized into four main areas:
Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease.

AIMS Only few data are available regarding a direct comparison of both non-invasive CMR and invasive EMB with respect to conformity of procedure-derived diagnoses in the same patients. The aim of this study was to elucidate the diagnostic performance of non-invasive cardiovascular magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB) in patients with troponin-I (TnI) positive acute chest pain in the absence of significant coronary artery disease (CAD). METHODS AND RESULTS One thousand one hundred and seventy-four consecutive patients who were admitted with TnI-positive acute chest pain between March 2004 and July 2007 underwent coronary angiography. In 1012 patients (86%), significant CAD (stenosis >50%) was detected as underlying reason for the acute chest pain. In 82 out of the remaining 162 patients without significant CAD, further workup was performed including both CMR and EMB. Cardiovascular magnetic resonance imaging alone enabled a diagnosis in 66/82 (80%) and EMB alone in 72/82 (88%) patients (P = 0.31). Myocarditis was the most frequent diagnosis by both CMR and EMB in this cohort and was detected with a higher frequency by EMB (58 vs. 81%; P < 0.001). With the combined approach comprising CMR and EMB, a final diagnosis could be established applying the 'Believe-The-Positive-Rule' in 78/82 patients (95%). This combined approach turned out to yield more diagnoses than either CMR (P < 0.001) or EMB (P = 0.03) as single techniques, respectively. Comparison of diagnostic CMR procedures with the corresponding diagnostic EMBs demonstrated a substantial match of diagnoses (kappa = 0.70). CONCLUSION Cardiovascular magnetic resonance imaging and EMB have good diagnostic performances as single techniques in patients with TnI-positive acute chest pain in the absence of CAD. The combined application of CMR and EMB yields a considerable diagnostic synergy by overcoming some limitations of CMR and EMB as individually applied techniques.
The Impact of Learning and Living Environment of Colleges on Dropout Rates: A Study Using Panel Data

This paper attempts to analyze how the learning and living environment of college affects the control of students’ withdrawal and graduation within standard academic years, using panel data. The panel data analysis reveals the possibility that the conditions of the learning environment, such as the convenience of libraries provided by colleges and the ratio of instructors to students, have a certain effect on the control of dropout rates in addition to students’ academic skills before college entry. This result suggests that there are differences in dropout rates and graduation rates between those colleges that have an environment to encourage motivation for learning and those that do not, even if their deviation scores are the same.
Prevalence of diabetic retinopathy in the United States, 2005-2008.

CONTEXT The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists. OBJECTIVES To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older. DESIGN, SETTING, AND PARTICIPANTS Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. MAIN OUTCOME MEASUREMENTS Diabetic retinopathy and vision-threatening diabetic retinopathy. RESULTS The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). CONCLUSION In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals.
Beta-blockers in worsening heart failure: good or bad?

The use of a β-blocker for the treatment of heart failure was for a long time contraindicated. The reasons were mainly due to concerns that the failing circulatory system needed adrenergic support, and anti-adrenergic actions would cause harm, as clearly stated by Gaffney and Braunwald in 1963.1 The first report of β-blocker therapy by Waagstein and colleagues in 19752 was followed by a report in 1979 from our group on improved survival.3 We published more extensive observations in 1980.4 However, it would take another 20 years before this treatment became widely accepted. In contrast, the use of a β-blocker in chronic heart failure (CHF) and left ventricular systolic dysfunction is now the best documented treatment and also the most effective in this condition. It has a class I recommendation and evidence level A in international guidelines.5 A remaining and unresolved concern is how to manage patients who deteriorate while on treatment with a β-blocker. This concern relates to the initial worry limiting the use of the agents. However, it is also well known that …
The President’s Global Health Initiative

The U.S. Global Health Initiative (GHI) represents the Obama administration’s new strategy for international development assistance in health. With a pledge of $63 billion over six years, GHI aims to fund PEPFAR and a set of broader global health issues (e.g., maternal and child health, nutrition, and neglected tropical diseases). GHI is also being framed as “smart power” whereby health would serve as a critical tool for U.S. foreign policy. However, as the U.S. enters a period of severe budgetary restraint and as domestic crises rise to the fore, the promise of global health reform could become illusory. The lack of coordination and coherence in the U.S. global health architecture, as well as the broader U.S. foreign assistance system, require fundamental changes in the U.S. approach to global health going forward. This article analyzes current weaknesses in the GHI strategy and makes four key suggestions for the transformation of the U.S. global health enterprise under GHI. These suggestions include: (1) the devotion of resources that are predictable, sustainable, and scalable to needs; (2) the development of a true “whole of government” approach; (3) greater collaboration with international partners for success; and (4) the encouragement of host country ownership.
Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial.

CONTEXT Observational studies have previously reported that elective intra-aortic balloon pump (IABP) insertion may improve outcomes following high-risk percutaneous coronary intervention (PCI). To date, this assertion has not been tested in a randomized trial. OBJECTIVE To determine whether routine intra-aortic balloon counterpulsation before PCI reduces major adverse cardiac and cardiovascular events (MACCE) in patients with severe left ventricular dysfunction and extensive coronary disease. DESIGN, SETTING, AND PATIENTS The Balloon Pump-Assisted Coronary Intervention Study, a prospective, open, multicenter, randomized controlled trial conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n = 301) had severe left ventricular dysfunction (ejection fraction < or = 30%) and extensive coronary disease (Jeopardy Score > or = 8/12); those with contraindications to or class I indications for IABP therapy were excluded. INTERVENTION Elective insertion of IABP before PCI. MAIN OUTCOME MEASURES Primary end point was MACCE, defined as death, acute myocardial infarction, cerebrovascular event, or further revascularization at hospital discharge (capped at 28 days). Secondary end points included all-cause mortality at 6 months, major procedural complications, bleeding, and access-site complications. RESULTS MACCE at hospital discharge occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the no planned IABP groups (P = .85; odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and 7.4% in the respective groups (P = .32; OR, 0.61 [95% CI, 0.24-1.62]). Fewer major procedural complications occurred with elective IABP insertion compared with no planned IABP use (1.3% vs 10.7%, P < .001; OR, 0.11 [95% CI, 0.01-0.49]). Major or minor bleeding occurred in 19.2% and 11.3% (P = .06; OR, 1.86 [95% CI, 0.93-3.79]) and access-site complications in 3.3% and 0% (P = .06) of the elective and no planned IABP groups, respectively. CONCLUSIONS Elective IABP insertion did not reduce the incidence of MACCE following PCI. These results do not support a strategy of routine IABP placement before PCI in all patients with severe left ventricular dysfunction and extensive coronary disease. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN40553718; clinicaltrials.gov Identifier: NCT00910481.
Vibrant Soundbridge can improve the most comfortable listening level in sensorineural hearing loss: Our experience with 61 patients

In auditory rehabilitation, the most comfortable listening level (MCL) is important because the conversation partners of patients with hearing impairment are often individuals with normal hearing. Thus, normalizing MCL can help patients with hearing loss to reduce the communication handicap with individuals with normal hearing. While active middle ear implants demonstrate comparable performance with conventional hearing aids (HA) with regard to functional hearing gain and speech intelligibility, little is known about the effect of middle ear implants on the MCL. Therefore, we evaluated the MCL of active middle-ear implants compared with that of conventional HA in patients with moderate and moderate-to-severe sensorineural hearing loss (SNHL). We found that the Vibrant Soundbridge (VSB) active middle-ear implant had a pure-tone threshold similar to conventional HA. However, the MCL in VSB-aided conditions was significantly lower (by ~10 dB) than for HA-aided conditions. In addition, the significant improvement in MCL was attributable to robust amplifications at 1 kHz and 2 kHz compared with conventional HA. VSB implantation nearly normalized MCL for patients with SNHL. In terms of normalizing MCL, VSB implantation is a good choice for hearing rehabilitation in patients with SNHL. This article is protected by copyright. All rights reserved.
An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study.

AIMS Incomplete endothelialization has been found to be associated with late stent thrombosis, a rare but devastating phenomenon, more frequent after drug-eluting stent implantation. Optical coherence tomography (OCT) has 10 times greater resolution than intravascular ultrasound and thus appears to be a valuable modality for the assessment of stent strut coverage. The LEADERS trial was a multi-centre, randomized comparison of a biolimus-eluting stent (BES) with biodegradable polymer with a sirolimus-eluting stent (SES) using a durable polymer. This study sought to evaluate tissue coverage and apposition of stents using OCT in a group of patients from the randomized LEADERS trial. METHODS AND RESULTS Fifty-six consecutive patients underwent OCT during angiographic follow-up at 9 months. OCT images were acquired using a non-occlusive technique at a pullback speed of 3 mm/s. Data were analysed using a Bayesian hierarchical random-effects model, which accounted for the correlation of lesion characteristics within patients and implicitly assigned analytical weights to each lesion depending on the number of struts observed per lesion. Primary outcome was the difference in percentage of uncovered struts between BESs and SESs. Twenty patients were included in the analysis in the BES group (29 lesions with 4592 struts) and 26 patients in the SES group (35 lesions with 6476 struts). A total of 83 struts were uncovered in the BES group and 407 out of 6476 struts were uncovered in the SES group [weighted difference -1.4%, 95% confidence interval (CI) -3.7 to 0.0, P = 0.04]. Results were similar after adjustment for pre-procedure lesion length, reference vessel diameter, number of implanted study stents, and presence of stent overlap. There were three lesions in the BES group and 15 lesions in the SES group that had > or =5% of all struts uncovered (difference -33.1%, 95% CI -61.7 to -10.3, P < 0.01). CONCLUSION Strut coverage at an average follow-up of 9 months appears to be more complete in patients allocated to BESs when compared with SESs. The impact of this difference on clinical outcome and, in particular, on the risk of late stent thrombosis is yet to be determined.
Situación somatofisiológica y nutricional de los jóvenes inmigrantes en España. Variación según género y procedencia

The 13 and 14 years of human life cycle are very sensitive to environment, so that migration and changes in living conditions related may influence further. The aim of this study is to characterize the nutritional and somatic status of the immigrant adolescent population of Madrid with the objectivity of bioanthropometric assessment. 519 adolescent students not born in Spain were evaluated. The sample was taken in the public schools of the Community of Madrid and conducted the following groups: Spanish control sample (38.9%), Latin America (50.9%), Magreb (4.5%), Asia (3.8%) and Eastern Europe (1.9%). The situation is Normal weight for the total sample, except in boys of Eastern Europe (Overweight). The pattern reflected a daily dietary intake of 3.73 +/- 0.91, being the dinner the most represented food. The diet quality as measured by KidMed showed that 10.2% followed a low quality diet, 58.6% have a better diet and 31.2% optimal. Higher scores were found in the Magreb group and lowest in Asia. In all groups showed a trend towards increased consumption of fruit and vegetables in Spain.
Etiopatogenia de los linfomas cutáneos de células T (micosis fungoide/síndrome de Sézary)

Mycosis fungoides and Sezary syndrome are the most frequent cutaneous T-cell lymphomas, Their aetiology and pathogenesis are almost unknown as well as the mechanisms by which early indolent stages progress into a more aggressive behaviour developing tumours and spreading to lymph nodes and internal organs. We review the factors implicated in its development and evolution: inheritance, environmental exposures, infectious agents, major histocompatibility antigens, genetic instability, cytokines and oncogenes. Although the development of advanced laboratory techniques has greatly enhanced our understanding of their etiopathogenesis, the significance of many implicated mechanisms is controversial and a matter of debate. New researches, based in the epidemiology and molecular biology will he necessary in order to resolve these questions and enhance the understanding of the disease.
Public reporting of hospital hand hygiene compliance--helpful or harmful?

PUBLIC REPORTING OF HOSPITAL PERFORMANCE HAS been proposed as a means of improving quality of care while ensuring both transparency and accountability. Organizations feel pressure to perform well, deriving from their desire to protect market share and defend reputations. This pressure, if effectively harnessed, can lead to an increase in quality improvement activities and better patient outcomes, although the evidence supporting the latter claim is mixed. In 2002, it was estimated that approximately 1.7 million hospital-acquired infections (HAIs) and 99 000 HAIrelated deaths occurred in the United States each year. Hand hygiene is considered the most important strategy to prevent HAIs. Since 2002, an increasing number of US states have mandated public reporting of quality indicators related to HAI prevention; to date, none have included reports of hand hygiene compliance in their mandates. This Commentary suggests the need for caution by states considering publicly reporting hand hygiene compliance as a mechanism to reduce HAI.