Miracle-dz/UniFAR-FTUs huggingface dataset:
Qualitative evaluation of an interdisciplinary chronic pain intervention: outcomes and barriers and facilitators to ongoing pain management

Background Many leaders in the field of chronic pain treatment consider interdisciplinary pain management programs to be the most effective treatments available for chronic pain. As programs are instituted and expanded to address demands for nonpharmacological chronic pain interventions, we need to better understand how patients experience program impacts, as well as the challenges and supports patients encounter in trying to maintain and build on intervention gains. Methods We conducted a qualitative evaluation of an interdisciplinary chronic pain coaching program at the Atlanta Veterans Affairs. A purposive sample of Veterans were engaged in interviews (n=41) and focus groups (n=20) to elicit patient outcomes and barriers and facilitators to sustainment of improvements. Transcripts were analyzed using matrix and thematic analyses. Results Veterans reported various outcomes. Most frequently they described adopting new self-care or lifestyle practices for pain management and health. They also often described accepting pain, being better able to adjust and set boundaries, feeling more in control, participating in life, and changing their medication use. A small portion of the sample reported no improvement in their conditions. When outcomes were examined as a whole, individuals described impacts that could be placed along a spectrum from whole life change to no change. Facilitators to maintenance of improvements included having building blocks (eg, carrying forward practices learned), support (eg, access to resources), and energy (eg, motivation), and improving incrementally. Challenges were not having building blocks (eg, life disruptions), support (eg, unknown follow-up options), and energy (eg, competing demands) and having an unbalanced rate of improvement. Conclusion Most Veterans identified experiencing multiple areas of improvement, especially learning about and taking up new pain and general health management skills. Ensuring participants can build on and find support for these outcomes when applying what they have learned in their dynamic social and physical worlds remains a challenge for this program and other relatively short-term interdisciplinary chronic pain interventions.
Solid lipid nanoparticles with enteric coating for improving stability, palatability, and oral bioavailability of enrofloxacin

Background The poor palatability, variable oral bioavailability, stimulation to gastric mucosa, and light instability limited the application of enrofloxacin (ENR). The enteric granules combining solid lipid nanoparticles (SLNs) with enteric coating were explored to overcome these disadvantages. Materials and methods ENR-loaded SLNs were produced by a hot homogenization and ultrasonic emulsification method and the enteric granules with SLNs as inner core were prepared by wet granulation followed by coating using polyacrylic resin II (PRII). The formulation was optimized by using orthogonal or single factor test screening. Results The optimal SLNs with loading capacity (LC) and price as inspection indexes were consisted of 10 mL 3% polyvinyl alcohol per 0.8 g ENR and 2.4 g octadecanoic acid. The sizes, LC, polydispersion index, and zeta potential of the SLNs were 308.5±6.3 nm, 15.73%±0.31%, 0.352±0.015, and −22.3 mv, respectively. The best enteric granules were used 15% PRII as coating materials. The release of the enteric granules in simulated intestine fluid (SIF, pH=8) was significantly faster than in simulated gastric fluid (SGF, pH=2) and simultaneously slower than those of SLNs and native ENR. The granules showed good stability in influencing factor experiment. The granules displayed a similar daily feed intake as the control group and higher daily feed intake than ENR powder and single-coating granules. Compared to the ENR soluble powder, the area under the plasma concentration–time curve and mean retention time of the enteric granules after intragastric administration were increased from 4.26±0.85 µg h/mL and 6.80±2.28 hours to 11.24±3.33 µg h/mL and 17.97±4.01 hours, respectively. Conclusion The enteric granules combination SLNs with enteric coating significantly improved the stability, palatability, sustained-release performance and oral bioavailability of ENR. The novel technology will be a potential measure to overcome the similar disadvantages of other drugs.
Evaluation of Gold Nanoparticle Size Effect on Dose Enhancement Factor in Megavoltage Beam Radiotherapy Using MAGICA Polymer Gel Dosimeter

Background: Gold nanoparticles (GNPs) are among the most promising radiosensitive materials in radiotherapy. Studying the effective sensitizing factors such as nanoparticle size, concentration, surface features, radiation energy and cell type can help to optimize the effect and possible clinical application of GNPs in radiation therapy. In this study, the radiation sensitive polymer gel was used to investigate the dosimetric effect of GNP size in megavoltage (MV) photon beam radiotherapy. Material and Methods: GNPs with the size of 30nm, 50nm and 100nm in diameter were used. Transmission electron microscope (TEM) and dynamic light scattering (DLS) were applied to analyze the size of nanoparticles. The MAGICA polymer gel was synthesized and impregnated with different sizes of GNPs. The samples were irradiated with 6MV photon beam and 24 hours after irradiation, they were read using a Magnetic Resonance Imaging (MRI) scanner. Macroscopic Dose Enhancement Factor (DEF) was measured to compare the effect of GNP size. The MAGICA response of the 6MV x-ray beam was verified comparing Percentage Depth Dose (PDD) curve extracted from polymer gel dosimetry and Treatment Planning System (TPS). Results: MAGICA polymer gel dose response curve was linear in the range of 0 to 10 Gy. DEFs by adding 30nm, 50nm and 100nm GNPs were 1.1, 1.17 and 1.12, respectively. PDD curves of polymer gel dosimeter and treatment planning system were in good agreement. Conclusion: The results indicated a substantial increase in DEF uses a MV photon beam in combination with GNPs of different sizes and it was inconsistent with previous radiobiological studies. The maximum DEF was achieved for 50nm GNPs in comparison with 30nm and 100nm leading to the assumption of self-absorption effect by larger diameters. According to the outcomes of this work, MAGICA polymer gel can be recommended as a reliable dosimeter to investigate the dosimetric effect of GNP size and also a useful method to validate the current radiobiological and simulation studies.
Application of the Marginal Beta-Binomial Model in Estimation the Overall Odds of Obesity Among Iranian Adults: Meta-Analysis Method

Context To obtain accurate and reliable estimation of overall obesity odds ratio (OR) a statistical method is needed to be designed to account for heterogeneity among studies. The marginal beta-binomial model is a new method with attractive features that make it robust for meta-analysis. Objectives The aim of this study is the estimation of overall obesity OR among Iranian adults with particularly attention to age, sex, place of residence, and smoking status. Data Sources We systematically reviewed all studies regarding obesity in Iranian adults in national and international journals that are published between 1990 and 2017, including PubMed, Scopus, SID, Google Scholar, Magiran, and IranMedex. The R software was used for data analysis and obtaining overall obesity OR using the marginal beta-binomial model. Results A total of 18 studies, with a sample size of 258283, were included in our analysis. Results showed that increasing age, female sex, and residence in urban areas increases the odds of obesity. Using the age group 20 - 30 years as the reference, the overall obesity ORs for 30 - 40, 40 - 50, 50 - 60, and 60+ years were 2.13, 3.33, 3.15, and 2.33, respectively. The overall obesity OR for women was 2.35, compared with men. The estimated odds of obesity were 53% higher for urban adults. Smoking has a negative effect on obesity; the OR of obesity for smokers was 0.48 compared with non-smokers. Conclusion Consistent results in our research can be used as a basis to reinforce health programs for prevention and treatment of obesity in Iran.
Comparison of Intranasal Dexmedetomidine and Oral Ketamine Versus Intranasal Midazolam Premedication for Children Undergoing Dental Rehabilitation

Background Dental rehabilitation surgery is associated with significant fear and anxiety with subsequent psychological disturbances. Midazolam has been used frequently as a premedication. However, it may be associated with side effects. Dexmedetomidine and ketamine combination has been suggested as an effective premedication in improving preoperative sedation and analgesia. Objectives This study compared the effects of combined intranasal dexmedetomidine and oral ketamine versus intranasal midazolam on anxiolysis and postoperative analgesia. Methods Seventy-six children (aged two to six years) undergoing dental rehabilitation under general anesthesia were assigned randomly to one of the two groups (n = 38 each) receiving either intranasal dexmedetomidine at 2 µg/kg and oral ketamine at 3 mg/kg (Group DK) or intranasal midazolam at 0.2 mg/kg (group M) 30 minutes prior to the anesthesia induction. The sedation levels and parental separation state were evaluated. Time to recovery, postoperative rescue analgesia, and postoperative adverse effects were assessed. Results Seventy-six children completed the study. Patients in group DK had significantly lower sedation scores than those in group M after 20 and 30 min (P < 0.05). The rate of satisfactory separation showed no statistically significant difference between the two groups 30 minutes after the administration of premedication (P = 0.926). A significantly higher number of patients in group M required rescue analgesic (42%) compared to those in group DK (16%) (P = 0.012). Conclusions Premedication with intranasal dexmedetomidine 2 µg/kg and oral ketamine 3 mg/kg is a rapid and effective alternative in children undergoing dental rehabilitation when compared to intranasal midazolam 0.2 mg/kg.
Effects of melatonin in children with attention-deficit/hyperactivity disorder with sleep disorders after methylphenidate treatment

Purpose Methylphenidate (MPH), the first-line medication in children with attention-deficit/hyperactivity disorder (ADHD), is associated with increased risk of sleep disorders. Melatonin has both hypnotic and chronobiotic properties that influence circadian rhythm sleep disorders. This study explores the effectiveness of melatonin in children with ADHD who developed sleep problems after starting MPH. Patients and methods This study, based on a clinical database, included 74 children (69 males, mean age 11.6±2.2 years) naturalistically treated with MPH (mean dosage 33.5±13.5 mg/d). The severity of sleep disorder (sleep onset delay) was recorded at baseline and after a follow-up of at least 4 weeks using a seven-point Likert scale according to the Clinical Global Impression Severity score. Effectiveness of melatonin on sleep (mean dosage 1.85±0.84 mg/d) after 4 weeks was assessed using a seven-point Likert scale according to the Clinical Global Impression Improvement (CGI-I) score, and patients who scored 1 (very much improved) or 2 (much improved) were considered responders. Results Clinical severity of sleep disorders was 3.41±0.70 at the baseline and 2.13±1.05 after the follow-up (P<0.001). According to the CGI-I score, 45 patients (60.8%) responded to the treatment with melatonin. Gender and age (children younger and older than 12 years) did not affect the response to melatonin on sleep. Patients with or without comorbidities did not differ according to sleep response. Specific comorbidities with disruptive behavior disorders (oppositional defiant disorder or conduct disorder), affective (mood and anxiety) disorders and learning disabilities did not affect the efficacy of melatonin on sleep. Treatment was well tolerated, and no side effects related to melatonin were reported. Conclusion In children with ADHD with sleep problems after receiving MPH treatment, melatonin may be an effective and safe treatment, irrespective of gender, age and comorbidities.
Dichloroacetic acid upregulates apoptosis of ovarian cancer cells by regulating mitochondrial function

Background Metabolic reprogramming is a characteristic of tumor cells and is considered a potential therapeutic target. Even under aerobic conditions, tumor cells use glycolysis to produce energy, a phenomenon called the “Warburg effect”. Pyruvate dehydrogenase kinase 1 (PDK1) is a key factor linking glycolysis and the tricarboxylic acid cycle. Dichloroacetic acid (DCA) reverses the Warburg effect by inhibition of PDK1 to switch cytoplasmic glucose metabolism to mitochondrial oxidative phosphorylation (OXPHOS). Methods Cell viability was examined using a standard MTT assay. Glucose consumption and l-lactate production were measured using commercial colorimetric kits, and intracellular lactate dehydrogenase (LDH) activity was evaluated using cell lysates and an LDH Quantification Kit. Real-time PCR was used to detect the expression of related genes. The production of total ROS was evaluated by staining with dichlorofluorescin diacetate. Results Comparison of various aspects of glucose metabolism, such as expression of key enzymes in glycolysis, lactate production, glucose consumption, mitochondrial oxygen consumption rate, and citric acid production, revealed that A2780/DDP cells were primarily dependent on glycolysis whereas A2780 cells were primarily dependent on mitochondrial OXPHOS. Mitochondrial uncoupling protein 2 (UCP2) protects against mitochondrial ROS while allowing energy metabolism to switch to glycolysis. Treatment of A2780 cells with various concentrations of DCA resulted in decreased expression of UCP2, a metabolic switch from glycolysis to mitochondrial OXPHOS, and an increase in oxidative stress induced by ROS. These effects were not observed in A2780/DDP cells with higher UCP2 expression suggesting that UCP2 might induce changes in mitochondrial functions that result in different sensitivities to DCA. Conclusion Our results show that a drug targeting tumor metabolic changes affects almost the entire process of glucose metabolism. Thus, it is necessary to comprehensively determine tumor metabolic functions to facilitate individualized antitumor therapy.
A review of small molecules and drug delivery applications using gold and iron nanoparticles

Conventional cancer treatment techniques show several limitations including low or no specificity and consequently a low efficacy in discriminating between cancer cells and healthy cells. Recent nanotechnology developments have introduced smart and novel therapeutic nanomaterials that take advantage of various targeting approaches. The use of nanotechnology in medicine and, more specifically, drug delivery is set to spread even more rapidly than it has over the past two decades. Currently, many nanoparticles (NPs) are under investigation for drug delivery including those for cancer therapy. Targeted nanomaterials bind selectively to cancer cells and greatly affect them with only a minor effect on healthy cells. Gold nanoparticles (Au-NPs), specifically, have been identified as significant candidates for new cancer therapeutic modalities because of their biocompatibility, easy functionalization and fabrication, optical tunable characteristics, and chemophysical stability. In the last decade, there has been significant research on Au-NPs and their biomedical applications. Functionalized Au-NPs represent highly attractive and promising candidates for drug delivery, owing to their unique dimensions, tunable surface functionalities, and controllable drug release. Further, iron oxide NPs due to their “superparamagnetic” properties have been studied and have demonstrated successful employment in numerous applications. In targeted drug delivery systems, drug-loaded iron oxide NPs can accumulate at the tumor site with the aid of an external magnetic field. This can lead to incremental effectiveness in drug release to the tumor site and vanquish cancer cells without harming healthy cells. In order for the application of iron oxide NPs in the human body to be realized, they should be biodegradable and biocompatible to minimize toxicity. This review illustrates recent advances in the field drug and small molecule delivery such as fluorouracil, folic acid, doxorubicin, paclitaxel, and daunorubicin, specifically when using gold and iron oxide NPs as carriers of anticancer therapeutic agents.
Massive hematemesis in a case of gastric amyloidosis masquerading as gastric carcinoma

under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the article is properly cited. a Post graduate Institute of Medical Education and Research, Department of Histopathology. Chandigarh, India. b Post graduate Institute of Medical Education and Research, Department of General Surgery. Chandigarh, India. c Post graduate Institute of Medical Education and Research, Department of Gastroenterology. Chandigarh, India. Massive hematemesis in a case of gastric amyloidosis masquerading as gastric carcinoma
Sympatholytic and Anti-Inflammatory Effects of Ropivacaine and Bupivacaine After Infraclavicular Block in Arterio Venous Fistula Surgery

Background Various mechanisms have been suggested for analgesic effects of drugs used in infra-clavicular block and each has contributed to pain relief. Objectives The aim of this study was to compare the degree of sympathetic block and measure tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-1 levels before and after infra-clavicular block with ropivacaine and bupivacaine in patients undergoing arterio venous fistula (AVF) surgery. Methods Forty-eight patients undergoing AVF surgery were randomly divided to two groups, undergoing infra-clavicular block with ropivacaine and bupivacaine. The bupivacaine group was blocked with 30 mL of 0.5% bupivacaine and in the ropivacaine group, the blockage was done with 30 mL of 0.5% ropivacaine. Infra-clavicular block was carried out by ultrasound in a vertical manner. Blood samples were taken before the block and one hour after the block to measure IL-1, IL-6, and TNF-alpha. Data were analyzed by covariance analysis and correlation t-test. Results T-correlation analysis showed that in both ropivacaine and bupivacaine groups, the TNF-alpha, IL-6, and IL-1 levels decreased after the block. Also, the increase in arterial diameter was significantly greater in ropivacaine group. Conclusions The present study showed that peripheral block with any single drug could reduce pre-inflammatory factors. On the other hand, ropivacaine significantly increased the diameter of the artery compared to the bupivacaine group.
Development of Military Concussion Readiness Inventory for Dizziness and Balance

Purpose The objective of this study was to develop and establish content validity of a new instrument titled the Military Concussion Readiness Inventory for Dizziness and Balance (MCRI-DB). The MCRI-DB was intended to recognize functional impairments and predict readiness for return-to-duty in service members who experienced mild traumatic brain injury (mTBI). Methods Nineteen male service members were included in a nominal group technique (NGT) process to produce items for the MCRI-DB. Items were categorized according to the International Classification of Functioning, Disability and Health (ICF) and were sent to 13 physical therapy experts through a Delphi survey to determine content validity. The consensus to include an item was defined as an agreement of at least 70% of the participants. Results The NGT produced 222 items with 108 duplicates removed. The ICF categorization linked 84 of the items to 36 unique ICF Codes, 9 items were not linkable to the ICF due to the complex nature of the activity, and 21 items were removed. After three rounds of the Delphi survey, 68 items were included in this instrument. Conclusion In this study, we successfully combined the use of service members’ experiences with expert opinion to determine content validity of the MCRI-DB. This instrument may be used for assessment of service members who have experienced mTBI to help identify environmental factors, functional activities, and body functions that may reduce the safe and efficient fulfillment of their duties and determine their ability to return-to-duty. Further research is needed to develop the psychometric properties of the instrument fully.
Chronic Myeloproliferative Neoplasms: Some Remaining Challenges

Following millennia of clinical medicine ’ s efforts to embrace personalized, more effective and kinder treatments, arguably, it is the lessons garnered from patients with chronic myeloid leukemia (CML) in the chronic phase (CP) that appear to be moving us closer to the prospect of precision cancer medicine. 1 The BCR- ABL1 fusion gene encodes the oncoprotein BCR-ABL1 with a constitutive active tyrosine kinase activity that is the sole primary driver of the CP of CML. The discovery in 1996 that this kinase activity could be inhibited by imatinib mesylate (imatinib), a ﬁ rst-generation tyrosine kinase inhibitor (TKI) was pivotal. It established a new paradigm of targeted treatment for diverse cancers, in which relatively nonspeci ﬁ c and often toxic drugs are gradually being replaced by a cornucopia of safer, and in some cases, better targeted therapies and immunotherapies. 2 Imatinib substantially and durably reduces the number of CML cells in the CP at a daily oral dose of 400mg, and the life expectancy of most patients now approaches that of the general population. 3 The greatest advance is in those patients who achieve a complete cytogenetic response within 2 years of starting imatinib leading to life spans indistinguishable from the general population. 4 These impressive results with imatinib therapy have had profound effects on the natural history of CML and its prevalence. Current estimates suggest that in the United States, where about 5500 new cases are diagnosed annually, the prevalence may well increase to about 120,000 by 2020 and to about 200,000 by 2050. 5 However, imatinib is far from perfect, with only approximately 60% of patients remaining on the standard daily dose of 400mg after 6 years due to either lack of drug tolerance or drug resistance. Imatinib induces responses also in the more advanced phases of CML, but these responses are not durable.