Miracle-dz/UniFAR-FTUs huggingface dataset:
The possibility of complete restoration of variable collimator response in SPECT imaging

Spatial resolution of SPECT imaging is mainly limited by the geometry of collimator holes. A long collimator hole with a small diameter improves the spatial resolution at the cost of low detection efficiency. With a finite size for the holes, the resolution changes as a function of the distance from the collimator surface. Lewitt et al. (1988) developed an approximate restoration algorithm to correct for the distance-dependent collimator blurring by the Fourier transform of sinogram. Van Elmbt et al. (1993) presented an analytical formula assuming an approximated resolution variation function. In this work, an accurate restoration procedure is investigated for a fan integral projection data based on the collimator hole geometry. The variable collimator response is illustrated as a fan-region integral of the radionuclide distribution, which is different from the conventional line integral, when using the FBP algorithm to reconstruct the image. In a parallel-beam acquisition geometry, if the radionuclide distribution is restricted to a bounded region, the line integral can be accurately computed from the fan integral near the boundary, then by a bootstrap technique, all these line integrals can be obtained. Therefore the variable collimator response can be completely restored theoretically.
Preoperative assessment of the older patient: a narrative review.

IMPORTANCE Surgery in older patients often poses risks of death, complications, and functional decline. Prior to surgery, evaluations of health-related priorities, realistic assessments of surgical risks, and individualized optimization strategies are essential. OBJECTIVE To review surgical decision making for older adult patients by 2 measures: defining treatment goals for elderly patients and reviewing the evidence relating risk factors to adverse outcomes. Assessment and optimization strategies for older surgical patients are proposed. EVIDENCE ACQUISITION A review of studies relating geriatric conditions such as functional and cognitive impairment, malnutrition, facility residence, and frailty to postoperative mortality and complications (including delirium, discharge to an institution, and functional decline). Medline, EMBASE, and Web of Science databases were searched for articles published between January 1, 2000, and December 31, 2013, that included patients older than 60 years. RESULTS This review identified 54 studies of older patients; 28 that examined preoperative clinical features associated with mortality (n = 1,422,433 patients) and 26 that examined factors associated with surgical complications (n = 136,083 patients). There was substantial heterogeneity in study methods, measures, and outcomes. The absolute risk and risk ratios relating preoperative clinical conditions to mortality varied widely: 10% to 40% for cognitive impairment (adjusted hazard ratio [HR], 1.26 [95% CI, 1.06-1.49] to 5.77 [95% CI, 1.55-21.55]), 10% to 17% for malnutrition (adjusted odds ratio [OR], 0.88 [95% CI, 0.78-1.01] to 59.2 [95% CI, 3.6-982.9]), and 11% to 41% for institutionalization (adjusted OR, 1.5 [95% CI, 1.02-2.21] to 3.27 [95% CI, 2.81-3.81]). ) Risk ratios for functional dependence relating to mortality ranged from an adjusted HR of 1.02 (95% CI, 0.99-1.04) to an adjusted OR of 18.7 (95% CI, 1.6-215.3) and for frailty relating to mortality, ranged from an adjusted HR of 1.10 (95% CI, 1.04-1.16) to an adjusted OR of 11.7 (95% CI not reported) (P < .001). Preoperative cognitive impairment (adjusted OR, 2.2; 95% CI, 1.4-2.7) was associated with postoperative delirium (adjusted OR, 17.0; 95% CI, 1.2-239.8; P < .05). Frailty was associated with a 3- to 13-fold increased risk of discharge to a facility (adjusted OR, 3.16 [95% CI, 1.0-9.99] to 13.02 [95% CI, 5.14-32.98]). CONCLUSIONS AND RELEVANCE Geriatric conditions may be associated with adverse surgical outcomes. A comprehensive evaluation of treatment goals and communication of realistic risk estimates are essential to guide individualized decision making.
Live vaccine against measles, mumps, and rubella and the risk of hospital admissions for nontargeted infections.

IMPORTANCE In low-income countries, live measles vaccine reduces mortality from causes other than measles infection. Such nonspecific effects of vaccines might also be important for the health of children in high-income settings. OBJECTIVE To examine whether the live vaccine against measles, mumps, and rubella (MMR) is associated with lower rates of hospital admissions for infections among children in Denmark. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study of Danish children born 1997-2006 and followed up from ages 11 months to 2 years (last follow-up, August 31, 2008). Nationwide Danish registers provided data on vaccinations and hospital admissions. The recommended vaccination schedule was inactivated vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) administered at ages 3, 5, and 12 months and MMR at age 15 months. MAIN OUTCOMES AND MEASURES Incidence rate ratios (IRRs) of hospital admissions for any infection, comparing receipt of MMR vs DTaP-IPV-Hib as the most recent vaccine. Risks, risk difference, and number needed to vaccinate were calculated for receiving MMR on time. RESULTS The study included 495,987 children contributing with 56,889 hospital admissions for any type of infection during 509,427 person-years (rate, 11.2 per 100 person-years). For the 456,043 children who followed the recommended schedule and received MMR after the third dose of DTaP-IPV-Hib, MMR (rate, 8.9 per 100 person-years) vs the third dose of DTaP-IPV-Hib (rate, 12.4 per 100 person-years) as the most recent vaccine was associated with an adjusted IRR of 0.86 (95% CI, 0.84-0.88) for any admission for infection. There were 19,219 children immunized out of sequence. The adjusted IRR was 0.87 (95% CI, 0.80-0.95) for those receiving MMR (rate, 9.9 per 100 person-years) after the second dose of DTaP-IPV-Hib (rate, 15.1 per 100 person-years). However, in the 1981 children who subsequently received the third dose of DTaP-IPV-Hib (rate, 12.8 per 100 person-years) after MMR, the IRR for hospital admissions for infection was significantly greater (adjusted IRR, 1.62 [95% CI, 1.28-2.05]). The risk of admission for an infection between ages 16 months and 24 months was 4.6% (95% CI, 4.5%-4.7%) for receiving MMR on time and 5.1% (95% CI, 5.0%-5.2%) for not receiving MMR on time. The risk difference was 0.5 percentage point (95% CI, 0.4-0.6), and the number needed to vaccinate with MMR before age 16 months to prevent 1 admission for any infection was 201 (95% CI, 159-272). CONCLUSIONS AND RELEVANCE In a cohort of Danish children, receipt of live MMR vs inactivated DTaP-IPV-Hib as the most recent vaccine was associated with a lower rate of hospital admissions for any infections. These findings require replication in other high-income populations.
Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review.

IMPORTANCE Small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm. OBJECTIVE To evaluate the clinical effectiveness of a perioperative, cardiac output-guided hemodynamic therapy algorithm. DESIGN, SETTING, AND PARTICIPANTS OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014. INTERVENTIONS Patients were randomly assigned to a cardiac output-guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care-free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay. RESULTS Baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, -0.3% to 13.9%]; P = .07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]). CONCLUSIONS AND RELEVANCE In a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output-guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rates. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN04386758.
PTEN encoding product： a marker for tumorigenesis and progression of gastric carcinoma

AIM: To detect the expression of PTEN encoding productin normal mucosa, intestinal metaplasia (IM), dysplasia andcarcinoma of the stomach, and to investigate its clinicalimplication in tumorigenesis and progression of gastriccarcinoma.METHODS: Formalin-fixed paraffin embedded specimens from184 cases of gastric carcinoma, their adjacent normal mucosa,IM and dysplasia were evaluated for PTEN protein expressionby SABC immunohistochemistry. PTEN expression wascompared with tumor stage, lymph node metastasis, Lauren'sand WHO's histological classification of gastric carcinoma.Expression of VEGF was also detected in 60 cases of gastriccarcinoma and its correlation with PTEN was concerned.RESULTS: The positive rates of PTEN protein were 100 %(102/102), 98.5 %(65/66), 66.7 % (4/6) and 47.8 %(88/184)in normal mucosa, IM, dysplasia and carcinoma of the stomach,respectively. The positive rates in dysplasia and carcinomawere lower than in normal mucosa and IM (P＜0.01). Advanced gastric cancers expressed less frequent PTEN thanearly gastric cancer (42.9 % v567.6 %, P＜0.01). The positiverate of PTEN protein was lower in gastric cancer with thanwithout lymph node metastasis (40.3 % v563.3 %, P＜0.01). PTEN was less expressed in diffuse-type than in intestinal-type gastric cancer (41.5 % v557.8 %,P＜0.05). Signet ringcell carcinoma showed the expression of PTEN at the lowestlevel (25.0 %, 7/28); less than well and moderatelydifferentiated ones (P＜0.01). Expression of PTEN was notcorrelated with expression of VEGF (P＞0.05). CONCLUSION: Loss or reduced expression of PTEN proteinoccures commonly in tumorigenesis and progression of gastriccarcinoma. It is suggested that PTEN can be an objective markerfor pathologically biological behaviors of gastric carcinoma.
Insulin therapy for type 2 diabetes mellitus.

IMPORTANCE The incidence and prevalence of type 2 diabetes mellitus are increasing. OBJECTIVE To review currently available insulin therapy, as well as evidence on the use, application, initiation, and intensification of insulin in the outpatient setting. EVIDENCE REVIEW Data sources included PubMed for trials and investigations in type 2 diabetes examining insulin use from January 1998 to April 2014. FINDINGS The hemoglobin A1c target for most patients with type 2 diabetes is 7% but needs to be modified when there is increased risk of hypoglycemia, reduced life expectancy, extensive comorbidities, or reduced resources. Insulin therapy may be considered early or late in the disease course; adverse effects include weight gain and hypoglycemia. Basal insulin can be added to oral hypoglycemic agents (generally stopping sulfonylureas) initially, and later, prandial insulin can be added in a stepwise fashion. Insulin treatment must be individualized, and there are a number of challenges to insulin initiation and intensification. CONCLUSIONS AND RELEVANCE Insulin can help achieve ideal hemoglobin A1c goals for patients with type 2 diabetes. Barriers such as adherence, patient preferences, clinician preferences, and resource allocation must be addressed.
Handbook of tremor disorders

Introduction, Definition, and Behavioral Classification The Role of Intrinsic Neuronal Oscillations and Network Ensembles in the Genesis of Normal and Pathological Tremors Current Concepts of Basal Ganglia Neurophysiology with Respect to Tremorgenesis' Mechanisms of Physiologic Tremor and Relationship to Essential Tremor Physiological Finger Tremor in Medical Students and Others Are Neurophysiological Techniques Useful in Differentiating Tremor? Central and Peripheral Mechanisms in Tremorgenesis Central Mechanisms of Experimental Tremor and Their Clinical Relevance Adrenoceptors in Tremor Mechanisms Positron Emission Tomography in Tremor Disorders Analysis of Tremor Wave Form is Essential Tremor Physiological? Pathaphysiology of Essential Tremor Physiological Classification of Essential Tremor Stereotaxis in the Management of Tremor - Physiological Basis and Current Practice Pathological and Neurochemical Basis of Essential Tremor Essential Tremor and Other Movement Disorders The Pharmacological Management of Essential Tremor Clinical Features of Tremor in Extrapyramidal Syndromes Problems in Measurement of Parkinsonian Tremor Some Physiological Aspects of Parkinsonian Tremor MPTP-induced Parkinsonism and Tremor Medical Management of Parkinsonian Tremor Normal and Abnormal Tremor in the Elderly Cerebellar Tremor Primary Orthostatic Tremor Primary Writing Tremor Tremor and Dystonia Trauma and Tremor Hemisphere Lesions and Tremor Tremor in Peripheral Neuropathy Midbrain Tremor Head Tremor Tremor Induced or Enhanced by Pharmacological Means Tremor in the Acquired Immune Deficiency Syndrome Psychogenic Tremor Vocal Tremor The Surgical Treatment of Tremor Disorders.
Samoocena masy ciała 13-latków w zależności od wskaźnika masy ciała rodziców

WSTĘP. Prawidlowa ocena wlasnej masy ciala jest elementem zapobiegania i kontroli nadwagi i otylości. Celem pracy byla analiza adekwatności oceny wlasnej masy ciala przez 13-latkow w Polsce w zalezności od wskaźnika masy ciala (BMI) rodzicow. MATERIAŁ I METODY. Analizy wykonano w 561-osobowej grupie 13-latkow i ich rodzicow. Badana grupa pochodzila z trzeciego etapu badan kohorty ogolnopolskiej reprezentatywnej grupy dzieci urodzonych w 1995 roku. Badanie wykonano metodą sondazu z wykorzystaniem ankiet dla dzieci i rodzicow. Pomiary wysokości i masy ciala przeprowadzily pielegniarki szkolne. W ocenie BMI 13-latkow wykorzystano normy referencyjne Światowej Organizacji Zdrowia. Wskaźnik BMI rodzicow obliczono na podstawie danych uzyskanych z ankiet. WYNIKI. Stwierdzono istotne statystycznie roznice w adekwatności oceny wlasnej masy ciala w zalezności od plci (p WNIOSKI. Masa ciala rodzicow wplywa na prawidlowośc oceny masy ciala ich 13-letnich dzieci, zwlaszcza corek. Dzialania zapobiegawcze i interwencyjne, ukierunkowane na zmniejszenie masy ciala nastolatkow, powinny byc skierowane do calej rodziny i uwzgledniac adekwatnośc oceny wlasnej masy ciala przez dzieci.
TOKYO criteria 2014 for transpapillary biliary stenting

It is difficult to carry out meta‐analyses or to compare the results of different studies of biliary stents because there is no uniform evaluation method. Therefore, a standardized reporting system is required. We propose a new standardized system for reporting on biliary stents, the ‘TOKYO criteria 2014’, based on a consensus among Japanese pancreatobiliary endoscopists. Instead of stent occlusion, we use recurrent biliary obstruction, which includes occlusion and migration. The time to recurrent biliary obstruction was estimated using Kaplan–Meier analysis with the log–rank test. We can evaluate both plastic and self‐expandable metallic stents (uncovered and covered). We also propose specification of the cause of recurrent biliary obstruction, identification of complications other than recurrent biliary obstruction, indication of severity, measures of technical and clinical success, and a standard for clinical care. Most importantly, the TOKYO criteria 2014 allow comparison of biliary stent quality across studies. Because blocked stents can be drained not only using transpapillary techniques but also by an endoscopic ultrasonography‐guided transmural procedure, we should devise an evaluation method that includes transmural stenting in the near future.
Refining the Phase I pediatric trial

Jeffrey M Skolnik1,2† & Jeffrey S Barrett2 †Author for correspondence 1AstraZeneca, LP, Mail Stop C2B-112, 1800 Concord Pike, PO Box 15437, Wilmington, DE 19850-5437, USA Tel. : +1 302 885 7686; Fax: +1 302 886 2622; E-mail: jeffrey.skolnik@ astrazeneca.com 2The Children’s Hospital of Philadelphia, Clinical Pharmacology & Therapeutics, Abramson Research Center, Room 916H, 3615 Civic Center Boulevard, PA 19104-4318, USA Tel. : +1 215 590 6359; Fax: +1 215 590 7544; E-mail: barrettj@ email.chop. edu ‘. despite these minor advances, pediatrics continues to use trial methodology first suggested over 60 years ago. ’
Catheter ablation of atrial ﬁbrillation in patients with heart failure: impact of maintaining sinus rhythm on heart failure status and long-term rates of stroke and death

Catheter ablation of atrial ﬁbrillation (AF) in patients with heart failure (HF) can improve left ventricular (LV) function and HF symptoms. We aimed to investigatewhether long-term maintenance of sinus rhythm impacts on hard outcomes such as stroke and death. to 45.8 + 12.8% ( P , 0.001). Recurrent AF was strongly predictive of stroke or death in HF patients (HR 8.33, 95% CI 1.86–37.7, P ¼ 0.001). Conclusion Long-term success rates for persistent (but not paroxysmal) AF ablation are signiﬁcantly lower in HF patients. Left ventricular function and HF symptoms were improved following ablation. In HF patients, recurrent arrhythmia strongly predicted stroke and death during follow-up. of stroke and death were examined in HF and non-HF cohorts over long-term follow-up. The impact of maintaining sinus rhythm on rates of stroke and death was examined. The survival in the HF group might be expected to depend on several factors including age, LV function, NYHA class, and the cause of HF. Therefore, to control for the effect of these other factors, a multivariate analysis was conducted to determine whether maintenance of sinus rhythm independently predicted stroke-free survival. The factors included in this multivariate analysis were as follows: freedom fromAF following the last procedure, age, gender, whether AF was initially persistent, the presence of ischaemic heart disease at baseline, LVEF at baseline, and NYHA class at baseline. A 54-year-old man with non-ischaemic dilated cardiomyopathy and implantation of an implantable cardioverter-deﬁbrillator (ICD) utilizing a Biotronik Linox SD 65/16 lead 8 years before presented with 17 ICD shocks. Interrogation of the ICD showed noise on the ventricular lead triggering repetitive ICD shocks. Device interrogation showed ventricular sensing of 11.3 mV, pacing impedance of 490 V , and shock impedance of 40 V , all consistent with prior testing. Pacing threshold could not be determined because pacing resulted in signiﬁcant ventricular noise. On chest X-ray, an externalized conductor cable proximal to the distal coil was suspected ( Panel A , arrows). A lead extraction was performed and inspection of the easily extractable lead showed an insulation failure with externalized pace-sense conductor cable (
Effect of everolimus on survival in advanced hepatocellular carcinoma after failure of sorafenib: the EVOLVE-1 randomized clinical trial.

IMPORTANCE Aside from the multikinase inhibitor sorafenib, there are no effective systemic therapies for the treatment of advanced hepatocellular carcinoma. OBJECTIVE To assess the efficacy of everolimus in patients with advanced hepatocellular carcinoma for whom sorafenib treatment failed. DESIGN, SETTING, AND PARTICIPANTS EVOLVE-1 was a randomized, double-blind, phase 3 study conducted among 546 adults with Barcelona Clinic Liver Cancer stage B or C hepatocellular carcinoma and Child-Pugh A liver function whose disease progressed during or after sorafenib or who were intolerant of sorafenib. Patients were enrolled from 17 countries between May 2010 and March 2012. Randomization was stratified by region (Asia vs rest of world) and macrovascular invasion (present vs absent). INTERVENTIONS Everolimus, 7.5 mg/d, or matching placebo, both given in combination with best supportive care and continued until disease progression or intolerable toxicity. Per the 2:1 randomization scheme, 362 patients were randomized to the everolimus group and 184 patients to the placebo group. MAIN OUTCOMES AND MEASURES The primary end point was overall survival. Secondary end points included time to progression and the disease control rate (the percentage of patients with a best overall response of complete or partial response or stable disease). RESULTS No significant difference in overall survival was seen between treatment groups, with 303 deaths (83.7%) in the everolimus group and 151 deaths (82.1%) in the placebo group (hazard ratio [HR], 1.05; 95% CI, 0.86-1.27; P = .68; median overall survival, 7.6 months with everolimus, 7.3 months with placebo). Median time to progression with everolimus and placebo was 3.0 months and 2.6 months, respectively (HR, 0.93; 95% CI, 0.75-1.15), and disease control rate was 56.1% and 45.1%, respectively (P = .01). The most common grade 3/4 adverse events for everolimus vs placebo were anemia (7.8% vs 3.3%, respectively), asthenia (7.8% vs 5.5%, respectively), and decreased appetite (6.1% vs 0.5%, respectively). No patients experienced hepatitis C viral flare. Based on central laboratory results, hepatitis B viral reactivation was experienced by 39 patients (29 everolimus, 10 placebo); all cases were asymptomatic, but 3 everolimus recipients discontinued therapy. CONCLUSIONS AND RELEVANCE Everolimus did not improve overall survival in patients with advanced hepatocellular carcinoma whose disease progressed during or after receiving sorafenib or who were intolerant of sorafenib. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01035229.